Therapy comparison between sMILE and Off-Flap Epi-LAsIK
Xiangfei Chen ,Yan Lu,Chunhong Wang , Liping Yang ,Zhenping Huang
Department of Endocrinology, Geriatric Research Center, Jinling Hospital, Nanjing General Hospital of PLA, School of Medicine, Nanjing University, Nanjing 210002, China Department of Ophthalmology, Jinling Hospital, Nanjing General Hospital of PLA, School of Medicine,Nanjing University, Nanjing 210002, China
Objective: To compare one-year clinical outcomes between small incision lenticular extraction (SMILE) and off-flap epipolis laser in situ keratomileusis (Epi-LASIK) for myopia. Methods: In this retrospective case-control study, choosing from Nanjing General Hospital of PLA between March 2013 and August 2014, 103 eyes of 52 patients underwent SMILE, and 86 eyes of 43 patients underwent off-flap Epi-LASIK.Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual astigmatism, and spherical equivalent (SE) were evaluated preoperatively, at 1 day, 1 week, at 1, 3, and 6 months, and at 1 year postoperatively. Contrast sensitivity (CS), modulation transfer function (MTF), and wavefront aberrations were evaluated at 1 year postoperatively. Data were analyzed using repeated measures analysis of variance, independent-samples t-tests, and Chi-square tests. results: At 1 day and 1 week after surgery,the UCVA for the SMILE group was significantly better than for the Epi-LASIK group (t=5.065, 5.994,respectively, P<0.001 for both); however for all other follow-up times, there were no significant differences
in the UCVA between the two groups. At 1 year postoperatively, there was no significant difference in the frequency of eyes SE within ±0.5 diopter (D) or within ±1.0 D between the two groups respectively.However, the frequency with which the SMILE group attained a cylindrical refractive error within ±0.5 D was clearly higher than for the Epi-LASIK group ( χ 2 =10.734, P=0.001). The CS with glare at low spatial frequency [3 and 6 cycles per degree (cpd)] in the SMILE group was significantly higher than for the Epi-LASIK group (t=4.106, 3.848, P<0.001). However, there were no significant differences in CS at other spatial frequencies, with or without glare between the two groups. Total order aberrations, lower-order aberrations,higher-order aberrations, spherical aberrations, coma, trefoil aberrations, and MTFs at all spatial frequencies with 4.0-mm pupils were not significantly different between the two groups. However with 6.0-mm pupils,higher-order aberrations and spherical aberrations of the SMILE group were significantly lower than inthe Epi-LASIK group (t=3.881, 6.843, P<0.001 each). There were no significant differences in the other aberrations between the two groups. The MTFs were significantly higher in the SMILE group than in the Epi-LASIK group with 6-mm pupils at low and high spatial frequency (5, 20, 25, 30 cpd) (t=3.272,P=0.001; t=2.926, P=0.004; t=3.280, P=0.001; t=3.975, P<0.001 respectively). There were no significant differences in the MTFs at residual spatial frequency between the two groups. conclusions: Both SMILE and off-flap Epi-LASIK are safe, efficient, stable, and predictable for the treatment of myopia. However,SMILE had better correction of astigmatic error, and with 6.0-mm pupils, SMILE had better visual quality than off-flap Epi-LASIK.
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