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. 2025 Jun;14(6):1237-1247.
doi: 10.1007/s40123-025-01138-7. Epub 2025 Apr 10.

Epithelial Remodelling in Myopia After Keratorefractive Lenticule Extraction

Maja Bohač  1 , Ivan Gabrić  2 , Sara Blazhevska  2 , Mateja Jagić  2 , Samuel Arba Mosquera  3
Affiliations

Epithelial Remodelling in Myopia After Keratorefractive Lenticule Extraction

Maja Bohač et al. Ophthalmol Ther. 2025 Jun.

Abstract

Introduction: We analyzed longitudinal epithelial changes after the treatment of myopia with keratorefractive lenticule extraction (KLEx) and the zonal change in epithelial thickness up to 12 months after SmartSight for myopic astigmatism with the SCHWIND ATOS femtosecond laser.

Methods: We used anterior segment optical coherence tomography (AS-OCT) data and analyzed changes in the epithelium after treatment to ascertain how much epithelium hyperplasia occurred after KLEx. Data from 80 eyes treated with SmartSight, with a complete follow-up from postoperative day 1 (POD1) to 12 months postoperative, were used. The mean age of the patients was 29 ± 6 years with a mean spherical equivalent (SEQ) of - 4.72 ± 1.97 diopters (D) (- 1.25 to - 9.88 D) and a mean magnitude of refractive astigmatism of 0.90 ± 0.89 D. Preoperative central epithelial thickness was from 46 to 67 µm.

Results: Postoperative central epithelial thickness at 12-month follow-up was 3 ± 5 µm thicker than preoperatively. The other epithelial zones (nasal, superior, temporal, inferior) thickened by + 4 ± 4 µm. The epithelial change showed larger variability at POD1 and stabilized from 1 week onwards. Postoperatively, the change in epithelium was not different for the different zones, and it did not correlate with the achieved refractive changes for any zone at any time point.

Conclusions: The changes in epithelial thickness after KLEx for moderate myopia with SmartSight were minimal, indicating a low level of epithelial hyperplasia without resembling a regression-inducing lentoid. Findings suggest that KLEx with SCHWIND ATOS has a subtle impact on the epithelial thickness (with postoperative epithelium becoming slightly thicker). However, the differences remain below any clinical relevance.

Keywords: Corneal laser refractive surgery; Epithelial remodelling; Femtosecond laser; KLEx; Lenticule; Myopic astigmatism.

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Conflict of interest statement

Declarations. Conflict of Interest: Samuel Arba Mosquera is an employee at and inventor in several patents owned by SCHWIND eye-tech-solutions. None of the other authors have financial or proprietary interests in materials or methods presented herein. Ethical Approval: All patients provided written informed consent (ICF) in accordance with the Declaration of Helsinki for both treatment and the use of de-identified clinical data for research purposes. The study was evaluated under the Medical Research Involving Human Subjects Act by the Specialty Eye Hospital Svjetlost and was deemed exempt from ethics approval due to its retrospective chart review nature. The purpose of this clinical research does not represent a clinical investigation. The medical device was used within its intended purpose without any additional invasive or patient burdensome procedures used.

Figures

Fig. 1
Fig. 1
a Presents refractive outcomes. SEQ was reduced to − 0.04 ± 0.15 D (from − 0.75 to + 0.13 D); astigmstism was reduced to 0.05 ± 0.22 D (from 0 to 1.50 D). All of them were stable from 1-week follow-up. b Presents astigmatism outcomes. Cardinal astigmatism was reduced to + 0.01 ± 0.04 D (from 0 to + 0.25 D); and oblique astigmatism was reduced to 0.00 ± 0.01 D (from − 0.01 to + 0.03 D); all of them were stable from 1-week follow-up
Fig. 2
Fig. 2
a Epithelial thickness (central and along horizontal and vertical meridians) throughout the follow-up. The epithelial thickness increased by 3 ± 5 µm essentially irrespective of the zone, without any signs of a lentoid refractive shape. b Longitudinal changes in epithelial thickness (central and along horizontal and vertical meridians) throughout the follow-up. The epithelial thickness increased by 3 ± 5 µm essentially irrespective of the zone, without any signs of a lentoid refractive shape
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