Influence of Changes in Anterior Segment Parameters on Intraocular Pressure Measurement after SMILE
Shuang Song1 , Tao Liang1 , Lin Leng2 , Shengnan Liu3 , Zhongtai Jiang1 , Meiguang Liu1
1Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
2Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, China
3Jinan Second People's Hospital, Jinan 250001, China
Abstract：Objective: To discuss the factors that influence intraocular pressure (IOP) after small incision lenticule extraction (SMILE), and to analyze the anterior segment parameters that influence changes in IOP.Methods: In this prospective clinical study, 141 patients (258 eyes) with myopic astigmatism who underwent SMILE surgery at the Affiliated Hospital of Qingdao University from June to November 2020 were enrolled. They were divided into three groups according to the residual stromal thickness (RST): 280 μm -320 μm in group A, 320 μm -360 μm in group B, >360 μm in group C. Tomography and biomechanical parameters of all eyes were obtained with Pentacam and Corvis ST, respectively. The changes in parameters were observed preoperatively and at 1, 3 and 6 months postoperatively. The data were analyzed by a measurement analysis of variance, Pearson linear correlation and paired t-test. Results: Except for the anterior chamber angle (ACA), the postoperative CCT, anterior chamber depth (ACD), anterior chamber volume (ACV) and other anterior segment morphological parameters in each group were generally lower than those before surgery, with statistically significant differences (all P<0.05). The first applanation time (A1T) and stiff parameter (SP-A1) decreased, the deformation amplitude (DA) and the peak distance (PD) at 6 months after the operation in the three groups were compared with those before the operation and Ambrosio relational thickness horizonal (ARTh) increase. For pairwise comparison between the groups, the ranges in the changes in ? A1T, ? A1V, ? DA, and ? PD in group A were greater than those for the other two groups, with statistically significant differences (all P<0.05). ? IOP and spherical equivalent (SE), preoperative IOP (IOPpre), ? CCT, changes in corneal volume (? CV), changes in central anterior chamber depth (? ACD) and changes in anterior chamber volume (? ACV) were positively correlated (all P<0.05). However, there was no correlation with the change in the anterior chamber angle (? ACA) (all P>0.05). In group A, ? ACD and ? ACV had a medium and low positive correlation with ? A1T, ? SP-A1, and ? ARTh, and a low negative correlation with ? DA (all P<0.05). A multiple linear regression equation of ? IOP was established for each group, and the corrected equation for the postoperative IOP was obtained: Group A, IOPpost corrected=IOPpost measured+0.572×IOPpre+15.759× ? ACD-2.401 (after adjustment R2 =0.55, P<0.001); Group B, IOPpost corrected=IOPpost measured+0.471×IOPpre+0.54×SE-1.099× ? CV-3.551 (after adjustment R2 =0.50, P<0.001); Group C, IOPpost corrected=IOPpost measured+0.447×IOPpre+0.304×SE-4.013 (after adjustment R2 =0.38, P<0.001). Conclusions: The changes in ACD and ACV have a positive correlation with ? IOP after SMILE. When the RST is in the range of 280-320 μm, the change in anterior chamber parameters should be considered in the measurement of IOP.
Ang M, Gatinel D, Dan ZR, et al. Refractive surgery beyond 2020. Eye(Lond), 2021, 35(2): 362-382. DOI: 10.1038/s41433- 020-1096-5.
[2]
Ma J, Wang Y, Hao W, et al. Comparative analysis of biomechanically corrected intraocular pressure with corneal visualization Scheimpflug technology versus conventional noncontact intraocular pressure. Int Ophthalmol, 2020, 40(1): 117-124. DOI: 10.1007/s10792-019-01159-9.
[3]
Chow SC, Yeung B. A review on different tonometers for intraocular pressure measurement after photorefractive keratectomy or small incision lenticule extraction. Clin Ophthalmol, 2020, 14: 3305-3323. DOI: 10.2147/OPTH. S278167.
[4]
Guo H, Hosseini-Moghaddam SM, Hodge W. Corneal biomechanical properties after SMILE versus FLEX, LASIK, LASEK, or PRK: a systematic review and meta-analysis. BMC Ophthalmol, 2019, 19(1): 167. DOI: 10.1186/s12886-019-1165- 3.
[5]
Ha A, Kim CY, Shim SR, et al. Degree of myopia and glaucoma risk: a dose-response meta-analysis. Am J Ophthalmol, 2021, 236: 107-119. DOI: 10.1016/j.ajo.2021.10.007.
[6]
Schuster AK, Erb C, Hoffmann EM, et al. The diagnosis and treatment of glaucoma. Dtsch Arztebl Int, 2020, 117(13): 225- 234. DOI: 10.3238/arztebl.2020.0225.
[7]
Dishler JG, Slade S, Seifert S, et al. Small-incision lenticule extraction (SMILE) for the correction of myopia with astigmatism: outcomes of the United States Food and Drug Administration premarket approval clinical trial. Ophthalmology, 2020, 127(8): 1020-1034. DOI: 10.1016/ j.ophtha.2020.01.010.
[8]
De Bernardo M, Cembalo G, Rosa N, et al. Reliability of intraocular pressure measurement by goldmann applanation tonometry after refractive surgery: a review different correction formulas. Clin Ophthalmol, 2020, 14: 2783-2788. DOI: 10.2147/ OPTH.S263856.
[9]
Ajazaj V, Kaçaniku G, Asani M, et al. Intraocular pressure after corneal refractive surgery. Med Arch, 2018, 72(5): 341-343. DOI: 10.5455/medarh.2018.72.341-343.
Schallhorn JM, Schallhorn SC, Ou Y. Factors that influence intraocular pressure changes after myopic and hyperopic LASIK and photorefractive keratectomy: a large population study. Ophthalmology, 2015, 122(3): 471-479. DOI: 10.1016/ j.ophtha.2014.09.033.
[12]
Jethani J, Dave P, Jethani M, et al. The applicability of correction factor for corneal thickness on non-contact tonometer measured intraocular pressure in LASIK treated eyes. Saudi J Ophthalmol, 2016, 30(1): 25-28. DOI: 10.1016/j.sjopt.2015.11.001.
[13]
Cui X, Yang Y, Li Y, et al. Correlation between anterior chamber volume and corneal biomechanical properties in human eyes. Front Bioeng Biotechnol, 2019, 7:379. DOI: 10.3389/ fbioe.2019.00379.
[14]
Hsia YC, Moghimi S, Coh P, et al. Anterior segment parameters as predictors of intraocular pressure reduction after phacoemulsification in eyes with open-angle glaucoma. J Cataract Refract Surg, 2017, 43(7): 879-885. DOI: 10.1016/ j.jcrs.2017.03.044.
[15]
Dooley I, Charalampidou S, Malik A, et al. Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery. Eye (Lond), 2010, 24(4): 519-526, 527. DOI: 10.1038/eye.2009.339.
[16]
Yassa ET, Ünlü C. Anterior chamber angle and volume do not change after myopic laser-assisted in situ keratomileusis in young patients. J Ophthalmol, 2018, 2018: 8646275. DOI: 10.1155/2018/8646275.
[17]
Kim BK, Mun SJ, Yang YH, et al. Comparison of anterior segment changes after femtosecond laser LASIK and SMILE using a dual rotating Scheimpflug analyzer. BMC Ophthalmol,2019, 19(1): 251. DOI: 10.1186/s12886-019-1257-0.
Wen D, McAlinden C, Flitcroft I, et al. Postoperative efficacy, predictability, safety, and visual quality of laser corneal refractive surgery: a network meta-analysis. Am J Ophthalmol, 2017, 178:65-78. DOI: 10.1016/j.ajo.2017.03.013.
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