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. 2023 Feb 18;16(2):301-308.
doi: 10.18240/ijo.2023.02.19. eCollection 2023.

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity: case series

Zhi Fang  1   2 , Xiao-Ying He  1   2 , Wei Han  1   2
Affiliations

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity: case series

Zhi Fang et al. Int J Ophthalmol. .

Abstract

Aim: To report the safety, efficacy, and accuracy of small-incision lenticule extraction (SMILE) or femtosecond-assisted laser in situ keratomileusis (FS-LASIK) for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography (AS-OCT).

Methods: Four patients with monocular corneal opacity (3 due to mechanical injury, 1 due to a firecracker wound) were recruited and treated with refractive surgery (3 for SMILE, 1 for FS-LASIK combined with limbal relaxing incision (LRI). Preoperative ocular manifestations, surgical details, postoperative visual outcomes, corneal opacity parameters, and corneal topography were analyzed.

Results: Preoperatively, spherical diopter ranged from -3.0 D to -4.75 D with cylinder ranging from -0.75 to -5.0 D, and corrected distance visual acuity (CDVA) ranging from 20/25 to 20/20. One eye's corneal opacity was located in the central zone and three were in the mid-peripheral optical zone. Three patients underwent uneventful SMILE in both eyes, whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye. CDVA of the eye with corneal opacity ranged from 20/22 to 20/20 one to six weeks postoperatively. Two patients achieved better CDVA and no patients lost Snellen lines. The postoperative diopter was within ±0.75 D for all eyes. Significant edema existed above the corneal opacity in one eye and dissipated soon. No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.

Conclusion: The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection. FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.

Keywords: corneal opacity; femtosecond-assisted laser in situ keratomileusis; small incision lenticule extraction.

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Figures

Figure 1
Figure 1. The preoperative corneal opacity was noted by slit-lamp microscopy (A, B; red arrow in B), AS-OCT examination before (C) and after (D) SMILE, corneal morphology before (E) and after (F) SMILE by Scheimpflug tomography system
AS-OCT: Anterior segment optical coherence tomography; SMILE: Small-incision lenticule extraction.
Figure 2
Figure 2. The preoperative AS-OCT examination of corneal opacity (A), slit-lamp microscopy (B, D, corneal opacity was indicated by red arrow) and AS-OCT examination (C, E) 2wk or 6wk after SMILE, respectively
AS-OCT: Anterior segment optical coherence tomography; SMILE: Small-incision lenticule extraction.
Figure 3
Figure 3. The corneal morphology before (A) SMILE, 2wk (B), or 6wk (C) after SMILE by Scheimpflug tomography system
SMILE: Small-incision lenticule extraction.
Figure 4
Figure 4. The preoperative slit-lamp microscopy (A, B, corneal opacity was indicated by red arrow), AS-OCT examination (C), and corneal topography (D) of corneal opacity
AS-OCT: Anterior segment optical coherence tomography.
Figure 5
Figure 5. The preoperative AS-OCT examination of corneal opacity
Slit-lamp microscopy (A: preoperative, corneal opacity was indicated by the red arrow; B: 1mo after surgery, C: 5mo after surgery, LRI was indicated by white arrow) and AS-OCT examination (D) 5mo after FS-LASIK and LRI of the right eye. AS-OCT: Anterior segment optical coherence tomography; LASIK: Laser in situ keratomileusis; LRI: Limbal relaxing incision.
Figure 6
Figure 6. The corneal topography before (A), 1mo (B), 3mo (C), and 6mo (D) after FS-LASIK combined with LRI in the right eye
FS-LASIK: Femtosecond laser in situ keratomileusis; LRI: Limbal relaxing incision.
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