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Nonlinear tissue processing in ophthalmic surgery
Published in Pablo Artal, Handbook of Visual Optics, 2017
Today these lasers have developed from a pure flap-maker for LASIK surgery [Rat 01] to a multiple tool for corneal surgery such as the generation of intrastromal pockets for corneal inlays and corneal rings, performing keratoplasties and arcuate incisions [Kym 12]. With the development of the SMILE® procedure (small incision lenticule extraction), the fs laser has even started to challenge the ArF-excimer laser technology since it uses only one femtosecond laser to complete the refractive surgery [Ang 12, Gan 14].
Quantitative Analysis of Human Corneal Lenticule Surface Microstructure Irregularity with 3D Optical Profiler Using White Light Interferometry
Published in Current Eye Research, 2021
Yanan Wu, Yan Wang, Zimiao Zhang, Xingchen Yu, Xinheng Zhao
Small incision lenticule extraction (SMILE) is one of the latest corneal refractive surgeries, which uses an all-in-one femtosecond laser system and provides flapless cutting in the corneal stroma.1,2 The lenticule is extracted through a small corneal incision ranging from 2–4 mm. A smooth intrastromal interface means better postoperative optical quality3 and a reduced inflammatory healing response. Intraoperative complications, such as suction loss or opaque bubble layer (OBL), may alter the cutting smoothness. The cap thickness has also been reported to influence surface irregularities in a previous study.4 Lenticule cutting quality directly affects postoperative visual quality5; therefore, it is necessary to evaluate the surface conditions and the surface roughness of the intrastromal interfaces.
Corneal Biomechanical Properties after Small Incision Lenticule Extraction Surgery on Thin Cornea
Published in Current Eye Research, 2021
With the development of refractive surgery, small incision lenticule extraction (SMILE) has been widely accepted for its safety, efficacy, and predictability.1,2 The collagen fibers in the cornea are arranged in an orderly fashion, which maintain the biomechanical strength of the cornea. After SMILE, a part of the stromal tissue is removed, and the cornea is reshaped. Irreversible alterations in the cornea after SMILE could affect its biomechanical properties by reducing the biomechanical strength, thus, possibly leading to corneal ectasia.3 Generally, high myopia is correlated with thinner values of the corneal thickness,4 and a thin cornea lower than 500 μm is one of the risk factors of iatrogenic ectasia.3 There is a minimum thickness (480 μm) accepted by the surgeons. With an increasing number of patients accepting refractive surgery, it is significant to provide more evidences to improve safety on relative thin cornea.
Review of Laser Vision Correction (LASIK, PRK and SMILE) with Simultaneous Accelerated Corneal Crosslinking – Long-term Results
Published in Current Eye Research, 2019
Elizabeth Wen Ling Lim, Li Lim
Corneal refractive surgery has evolved tremendously in the past few decades. The first laser photorefractive keratectomy (PRK) was performed almost three decades ago.1,2 PRK, though effective, has significant drawbacks such as iatrogenic corneal haze and limited predictability especially for higher diopteric corrections.1,2,3 Laser in-situ keratomileusis (LASIK) has since overtaken PRK to become the most commonly performed refractive surgical technique since it has quick visual recovery, good refractive outcomes, a low incidence of corneal haze and minimal post-operative discomfort.4 However, LASIK involves the creation of a corneal flap which may weaken the corneal structure and decrease corneal rigidity.5,6 This could increase the risk of LASIK regression and post-LASIK ectatic conditions. Small-incision lenticule extraction (SMILE) is a new femtosecond laser technique which does not require corneal flap creation.7 It is equally as effective as LASIK and may result in a higher corneal biomechanical strength.7