1 Research Unit of Ophthalmology, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU2 Institut for Klinisk Medicin - Øjenafdelingen (Oftalmologi), NBG3 Aarhus Universitetshospital4 Research Unit of Ophthalmology, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU
Femtosecond laser based small incision lenticule extraction for moderate and high myopia. Jesper Hjortdal, Sven Asp, Anders Ivarsen, Anders Vestergaard Department of Ophthalmology, Aarhus University Hospital, Denmark Purpose: ReLEx® smile is a new keratorefractive procedure whereby a stromal lenticule is cut by a femtosecond laser and manually extracted through a peripheral corneal tunnel. The purpose of the prospective quality study is to present our initial clinical experience with ReLEx smile for treatment of moderate and high myopia. Methods: 379 eyes (198 patients) were treated for myopia (spherical equivalent (SE) ranging from -13.13 to -1.63 D, mean -7.28 D) with ReLEx smile and followed for 3 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), proportion of eyes within ± 0.5/1.0 D, loss/gain of lines of CDVA, patient satisfaction, and complications were registered. Results: In total, 332 eyes completed the 3-month follow up. For eyes with emmetropia as target refraction, 83% had an UDVA of ≥20/25 (logMAR ≤0.1) at day 1 after surgery, increasing to 91% at 3 months. Nine eyes lost ≥ 2 lines of CDVA, and 42 eyes lost 1 line of CDVA. Loss of CDVA was mainly caused by interface scatter, and occurred mostly during the initial period of the study. Two eyes gained 2 lines, and 53 eyes gained 1 line of CDVA at the 3-month follow-up. Comparing attempted vs. achieved correction, the proportion of eyes within ± 0.50 D was 77.1 %, and 94.3% were within ± 1.0 D. The difference in attempted vs. achieved SE correction was -0.13 ± 0.49 D (range 1.50 to -1.88 D). Ninety-five percent of the patients would recommend refractive surgery to others. Conclusions: ReLEx smile is a flapless all-in-one femtosecond laser refractive procedure. Refractive predictability, safety and patient satisfaction at 3 months seems equal to ReLEx flex and FS-LASIK. Optimizing laser energy settings and surgeon experience is important to minimize initial inferior results.