Sie können Operatoren mit Ihrer Suchanfrage kombinieren, um diese noch präziser einzugrenzen. Klicken Sie auf den Suchoperator, um eine Erklärung seiner Funktionsweise anzuzeigen.
Findet Dokumente, in denen beide Begriffe in beliebiger Reihenfolge innerhalb von maximal n Worten zueinander stehen. Empfehlung: Wählen Sie zwischen 15 und 30 als maximale Wortanzahl (z.B. NEAR(hybrid, antrieb, 20)).
Findet Dokumente, in denen der Begriff in Wortvarianten vorkommt, wobei diese VOR, HINTER oder VOR und HINTER dem Suchbegriff anschließen können (z.B., leichtbau*, *leichtbau, *leichtbau*).
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.
Prior Presentation: Parts of the manuscript were presented at the 29th Winter ESCRS; 28 February–2 March 2025, Athens, Greece.
Key Summary Points
Why carry out this study?
Topographic regression is often linked to changes in the corneal epithelium’s morphology induced by alterations in stromal curvature during surgery.
Various laser vision correction techniques, including surface ablations such as photorefractive keratectomy (PRK), intrastromal ablations such as laser-assisted keratomileusis (LASIK), and keratorefractive lenticule extraction (KLEx) procedures like small incision lenticule extraction (SMILE), experience differing levels of epithelial hyperplasia, which contributes to topographic or corneal regression.
What was learned from the study?
SmartSight treatments caused a subtle (below clinical relevance) but statistically significant change in epithelial thickness.
The change in epithelial thickness from pre- to postoperatively was 3 ± 5 µm, regardless of the zone and follow-up time.
The epithelial changes did not resemble a refractive lentoid.
Introduction
Since the introduction of laser vision correction (LVC) [1] in the form of photorefractive keratectomy (PRK) [2], laser-assisted keratomileusis (LASIK) [3], or keratorefractive lenticule extraction (KLEx) [4], the long-term stability of these corrections has been debated [5].
Anzeige
The tendency for postoperative refraction to revert to its presurgical state is known as refractive regression [6]. However, it is important to differentiate between topographic or corneal regression—where the corneal curvature reverts to its original shape—and refractive progression, where the eye’s refraction changes back to preoperative values as a result of factors like continued axial elongation [7]. Topographic regression is often linked to changes in the corneal epithelium’s morphology induced by alterations in stromal curvature during surgery [8].
Various LVC techniques, including surface ablations such as PRK [9], intrastromal ablations such as LASIK [10], and KLEx procedures like small incision lenticule extraction (SMILE) [11], experience differing levels of epithelial hyperplasia, which contributes to topographic or corneal regression.
Numerous imaging modalities exist for assessing the corneal epithelium after LVC, including anterior segment optical coherence tomography (AS-OCT) and ultrahigh-frequency (UHF) imaging. Epithelial remodelling post LVC PRK, LASIK, or KLEx likely occurs as a result of epithelial migration driven by changes in the corneal curvature gradient. This remodelling influences post-LVC regression by “filling in the gaps” in areas where ablation was extensive while thinning in regions where corneal curvature has increased. However, regression only occurs if the epithelial regrowth (the remodelling) adopts the shape of a lens (lentoid). In contrast, uniform global hyperplasia does not contribute to refractive regression.
Corneal refractive surgery reshapes the cornea by removing tissue to correct optical and visual defects, fundamentally altering its geometry to improve vision. Understanding how epithelial thickness changes impact postoperative outcomes is crucial for optimizing these surgical procedures and achieving lasting results.
Anzeige
Sphero cylindrical refractions can be expressed in the form of power vectors (representing defocus, cardinal, and oblique astigmatism) representing independent components of the composite refraction. This is similar to the spherical equivalent (defocus) and Jackson cross cylinders, with cardinal astigmatism representing the 0/90 astigmatism component (with- and against-the-rule astigmatism), whereas the oblique astigmatism represents the 45/135 astigmatism component.
SmartSight treatment (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) is a lenticule creation and extraction method implemented in the SCHWIND ATOS femtosecond system (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) [12].
This work aimed to determine the extent of epithelial remodelling after KLEx treatment of myopic eyes beyond the value of the central epithelial thickness.
The rationale that refractive changes might influence epithelial thickness is based on the fact that epithelial remodelling is known after corneal LVC. It could be hypothesized that epithelial remodelling (for the otherwise same correction) may differ for different techniques or even devices using the same technique, along with different treatment plan strategies.
For the purpose of this work, we define epithelial remodelling as central epithelial remodelling (thickening or thinning) with respect to the preoperative values. Previous literature on myopic corrections supports postoperative central thickening, sometimes used under the term hyperplasia [13, 14].
The purpose and meaning of this work may help in improving treatment design to achieve better outcomes in laser-driven lenticule extraction procedures.
Methods
This retrospective, observational study analyzed a series of patients treated with the SmartSight technique for the correction of myopia with or without astigmatism at the Specialty Eye Hospital Svjetlost in Zagreb, Croatia. Prior to the procedure, patients were comprehensively informed about the associated risks and benefits. 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. This clinical research does not constitute a clinical investigation, as the medical device was employed within its intended purpose without additional invasive or burdensome procedures for patients.
The study analyzed records and charts from 80 eyes of 40 patients treated with the SmartSight profile for myopia correction, with or without astigmatism.
Anzeige
Evaluations included comparisons of preoperative data with postoperative outcomes at postoperative day 1 (POD1), 1 week, 1 month, and 3, 6, and 12 months. Standard refractive outcomes in LVC were assessed, alongside changes in epithelial thickness at horizontal and vertical meridians within 6–8 mm diameters (five values) [15]. Central epithelial thickness was analyzed on the basis of the average within a 3-mm ring. The nasal, temporal, inferior, and superior epithelial thickness at 6 mm and 8 mm were calculated as the average of the corresponding epithelial thickness quadrant segments for the 5–7 mm and 7–9 mm diameter annuli.
Corneal topographic and tomographic scans were obtained using an MS-39 optical coherence tomography (OCT) device (Costruzione Strumenti Oftalmici, Florence, Italy) [16]. Two experienced technicians conducted all scans, capturing at least three consecutive images per eye. The highest-quality image was selected for analysis.
Refractive outcomes were expressed in terms of spherical equivalent (SEQ) and cylindrical correction. Changes in corneal epithelial values were recorded in micrometers (µm).
All treatments were performed between November 2022 and April 2023 at a single center by three surgeons using KLEx profiles in SmartSight with the SCHWIND ATOS laser system. The surgical technique has been previously described in the literature [17].
Anzeige
No specific inclusion or exclusion criteria were applied beyond the requirement that patients had undergone SmartSight treatment for myopia with or without astigmatism and had completed the full 12-month follow-up. Charts were selected consecutively from the specified period. All patients underwent bilateral surgery, and both eyes were included in the analysis.
To increase the sample size, both eyes per patient were considered; however, statistical analyses used the number of patients rather than the number of eyes to determine significance, while all eyes were included to assess mean values.
Considering a standard deviation (SD) of epithelial remodelling of 3.5 µm, consistent with previous studies by Pradhan et al. [18] and de Ortueta et al. [14], a minimum sample size of 40 patients is required to detect a mean epithelial thickening of 1.5 µm with adequate statistical power.
The mean patient age was 29 ± 6 years (range 20–51 years). The mean preoperative spherical equivalent was − 4.72 ± 1.99 D (range − 1.25 to − 9.88 D), with mean preoperative astigmatism of 0.90 ± 0.89 D (range 0.00 to 5.00 D).
Anzeige
Preoperative Assessment
All the patients underwent a complete ophthalmologic examination prior to surgery, including manifest refraction, cycloplegic refraction, and corneal topography (MS-39, CSO, Italy). Corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) were evaluated using standardized optometric protocols. CDVA measurements were obtained utilizing trial frames and not contact lenses. All visual acuity assessments were conducted monocularly under controlled lighting conditions. Prior to the procedure, a comprehensive medical and ocular history was collected from each patient, including details on prior contact lens use, systemic and ocular medications, and any preexisting ophthalmic conditions.
Surgical Procedure
All treatments were performed using the SCHWIND ATOS in Lenticule mode (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany). The devices meet European conformity standards (CE marking) but are not FDA-approved.
Sphere and cylinder values entered into lasers were based on manifest refraction with nomogram adjustments (up to 10%) based on surgeon experience, patient age, myopia level, and optical zone size. Analyses were performed as deviation from the planned correction, instead of clinical target. Caps were 120 µm thick, the optical zones ranged from 6.5 to 7.5 mm, cap diameters were set between 8.8 and 9.0 mm, with superior incision at 90°, an entry angle of 120° and incision length of 2.5–3.5 mm (irrespective of the laterality). The optical zone depended on scotopic pupil size and attempted correction. The SmartSight profile included a refractive progressive transition zone (up to 0.8 mm) [19], tapering the lenticule edge without a minimum-thickness pedestal [20]. The system calculated the transition zone size based on preoperative refraction and optical treatment zone. Lenticule diameters ranged from 7.3 to 8.0 mm.
Before surgery, a topical anesthetic (Novesin™, OmniVision GmbH, Puchheim, Germany) was applied at 2-min intervals. Standardized cleaning with 2.5% povidone-iodine was followed by sterile draping to isolate the surgical field. A lid speculum was used for maximum exposure.
Patients fixated on a light target for centration [21]. The SCHWIND ATOS femtosecond laser was used for the SmartSight procedure. The cone, a disposable patient interface with a curved contact glass, was connected to suction ports, and the patient’s eye was positioned under it while fixating on the target light.
Eye alignment was achieved via an infrared tracker with simultaneous limbus, pupil, and torsion tracking integrated into the laser system and centered on the corneal vertex using topography data. Eye-tracker-guided centration was used for docking [22, 23]. The operator aligned the pupil with the target position, applied 250 mmHg suction, and verified positioning. Cyclotorsion control was based on the last valid eye-tracker frame before treatment [24].
Three experienced surgeons followed an identical protocol. Automatic cyclotorsion control was verified before the surgery.
The SCHWIND ATOS operates in the low-density plasma region [25], above the laser-induced optical breakdown threshold [26] but below the photodisruption regime [27]. Pulse energies ranged from 80 to 105 nJ [18], with a total energy dose between 440 and 583 mJ/cm2
After lenticule creation, suction was released automatically, and a blunt spatula was used to separate and extract the lenticule. The cornea was then gently massaged from the 6 o’clock position towards the incision to spread the cap evenly and minimize Bowman’s wrinkles [28]. Finally, residual tissue was checked for material or tears.
Postoperative Evaluation
For this cohort, the whole set from the preoperative to the 12-month postoperative examination visit was retrieved, including POD1, 1-week, 1-month, and 3-, 6-, and 12-month follow-up visits. Postoperative examinations included UDVA, CDVA, manifest refraction, corneal tomography (MS-39), and slit lamp examination. The postoperative therapy was the same for all patients.
Further analysis was performed to determine the correlations between the change in epithelial thickness compared to preoperative epithelial thickness and refractive outcomes after performing the SmartSight procedure.
Statistical Analysis
The analysis evaluated the changes for all the eyes, preoperatively vs. at different follow-up times. The normality of the samples has been estimated using a back-of-the-envelope test for the sample size of 40 patients (leading to a 2.3-SD estimate). Paired Student t tests were used to evaluate the differences between preoperative and postoperative visits. A p value less than 0.05/6 (0.0083 applying Bonferroni correction) was considered statistically significant.
Results
The records and charts of 80 eyes of 40 patients treated consecutively within a period of time with SmartSight KLEx for the correction of myopia with or without astigmatism were evaluated.
SEQ spherical equivalent, Dcyl cylinder diopter, N/A not acquired
Refractive outcomes are presented in Fig. 1. Spherical equivalent was reduced to − 0.04 ± 0.15 D (from − 0.75 D to + 0.13 D); astigmatism was reduced to 0.05 ± 0.22 D (from 0 to 1.50 D); 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. 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
Epithelial thickness (central and along horizontal and vertical meridians) throughout the follow-up is represented in Fig. 2a. The epithelial thickness increased by 3 ± 5 µm essentially irrespective of the zone, without any signs of a lentoid refractive shape.
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
Figure 2b shows 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.
There was no statistically significant correlation between the magnitude of correction—quantified in terms of refractive power, stromal ablation depth, and maximum peripheral slope—and the extent of induced hyperplasia.
Many of the analyzed parameters, as determined by a back-of-the-envelope test, did not follow a normal distribution: age, magnitude of the astigmatism, refraction, and epithelial thickness.
Discussion
The short-term stability of LVC has been questioned in the past [29]. A transient overcorrection evolving to a “final” refraction has traditionally been considered a weakness of PRK compared to LASIK or KLEx (SMILE, SmartSight), where the final refraction is achieved more rapidly [30]. Previous studies on PRK and LASIK have sought to distinguish topographic or corneal regression from refractive progression [31].
Among the factors influencing short- to mid-term variations in the anterior corneal surface, the epithelium plays a primary role [9]. Both LASIK [32] and SMILE [13] procedures commonly result in epithelial hyperplasia.
This study evaluated 80 eyes of 40 patients consecutively treated with a KLEx profile for the correction of myopia up to − 10 D, with or without astigmatism. Spatially resolved epithelial thickness was measured before and after SmartSight. In statistical analysis, the number of patients was used to determine significance, while data from all eyes were retained to calculate mean values.
Since this is an observational retrospective study, there were no inclusion and exclusion criteria other than having completed record for the relevant follow-up. The inclusion and exclusion criteria actually refer to the suitability for treatment, and not for enrolment in the study itself. Previous works [13, 14] did split refractive correction into low, moderate, and high corrections; but we are not aware of publications evaluating epithelial remodelling with respect to age (although intuitively differences among different age groups could be hypothesized). However creating two-dimensional bins of refractive power and age, e.g., in a 3 × 3 split (low, moderate, high power × young, moderate, older age) would result in low sample sizes per group, reducing the statistical power; whereas creating two sets of one-dimensional bins—one for power and another for age—would not account for cross effects.
Considering an SD of 3.0 µm for epithelial remodelling, compatible with previous studies [14, 16], a total sample size exceeding 40 patients is required to detect an epithelial thickening of 3.0 µm across three groups (> 13 patients per group, stratified by either power or age).
For an SD of 2.5 µm, also consistent with prior literature [14, 16], a total sample size exceeding 40 patients is necessary to detect an epithelial thickening of 4.4 µm across nine groups (> 4 patients per group, with a 3 × 3 factorial design for power and age).
To achieve a detection threshold of 2.0 µm for epithelial thickening, an overall sample size exceeding 108 patients is required (> 36 patients per group in a three-group comparison). Alternatively, in a 3 × 3 factorial design, a total of > 225 patients is necessary (> 25 patients per group across nine groups).
Outcomes were tracked longitudinally from POD1 to the 12-month follow-up. Previous studies indicate that epithelial remodelling stabilizes after 1 month, with no significant differences between 1-month and 12-month follow-ups [33].
Epithelial thickness changes were minor and uniform across all zones, reinforcing the finding that only minimal epithelial hyperplasia was induced. Changes in epithelial thickness along the horizontal and vertical meridians at 6- to 8-mm diameters (five values including the center) were negligible (approx. 3 ± 5 µm), indicating low epithelial hyperplasia. These changes resembled overall thickening rather than regression-inducing lentoid formation [34].
This low impact may be attributed to the moderate myopic corrections included in this cohort, as well as the demonstrated low induction of higher-order aberrations by the studied platform for low and moderate myopic corrections. The large optical zone (≥ 6.5 mm) and progressive transition zone (≤ 0.8 mm) further contributed to this outcome [18].
Unlike previous studies [30], no statistically significant correlation was found between the amount of correction (in terms of refractive power, stromal ablation depth, and maximum peripheral slope) and induced hyperplasia.
Postoperative epithelial remodelling reduces overall corneal surface roughness [35]. Following surgery, epithelial regrowth compensates for surface irregularities. Ideally, epithelial renewal would mitigate laser-induced aberrations, thereby reducing overall corneal aberrations [36].
Epithelial thickness modulations following tissue removal can be theoretically predicted using the model reported by Huang et al. [37] to explain clinically observed regression and aberration induction. We hypothesize that the smooth stromal bed [38] achieved with the laser platform, combined with the large optical zone and transition zone, resulted in reduced epithelial remodelling.
Growing evidence highlights the corneal epithelium’s significant contribution to total ocular refraction and corneal net power. Epithelial refractive power alone has been reported as 0.85 D (range 0.29–1.60 D) within a 3.6-mm diameter zone and 1.03 D (range 0.55–1.85 D) within a central 2-mm-diameter zone [39]. Other studies have reported lower values for epithelial optical power [14, 40].
This retrospective study has inherent limitations, including a limited sample size with multiple follow-ups. The inclusion of control groups would help determine whether SmartSight leads to reduced epithelial remodelling.
The primary aim of this study was to assess the effects of lenticule extraction procedures on epithelial thickness. This retrospective case series evaluated postoperative outcomes up to 12 months following myopic SmartSight treatment. Additionally, the study sought to correlate epithelial thickness changes with the outcomes of SmartSight lenticule extraction for myopic astigmatism.
To our knowledge, no previous studies have assessed the impact of SmartSight on zonal epithelial thickness, although numerous publications have examined postoperative epithelial changes following lenticule extraction [11, 16, 40‐42]. In this cohort, SmartSight resulted in a postoperative epithelial thickening of 3 ± 5 µm across all zones, consistent with findings observed after transepithelial ablations [11]. At least in part, this may be explained by the uncertainty of the measurements and the regression to the mean statistical effect [43].
Several limitations and potential confounding factors should be acknowledged. Both eyes of patients were included rather than randomly selecting one eye per patient. To account for this, statistical significance was determined using the number of patients rather than the number of eyes.
As a result of the retrospective nature of this study, a formal analysis of the incidence and severity of opaque bubble layers (OBLs), which may influence epithelial thickness changes, could not be conducted [44].
SmartSight is a KLEx procedure performed using the SCHWIND ATOS system. Future studies should assess whether these findings generalize to other lenticule extraction techniques. A comparative, paired-eye study—where one eye undergoes SmartSight and the other a different technique—would provide valuable insight. However, for a sample size of sufficient power, a non-paired approach, as used in this study, may also be viable.
To estimate the required sample size post hoc, the following parameters were used: SD of epithelial thickness (2.2 µm). To detect a clinically relevant difference (1 µm), the required sample size for α = 5% and 80% statistical power was 39 independent samples. The inclusion of 80 eyes (40 patients) met this requirement.
Considering the measurement resolution of epithelial thickness (3.6 µm), detecting a difference of 1.6 µm would require the same sample size.
Finally, other potential confounding factors, such as cap thickness, may influence epithelial remodelling. However, the observed differences appear clinically insignificant.
Conclusions
The observed changes in epithelial thickness following SmartSight KLEx were minimal (approx. 3 ± 5 µm), suggesting a negligible degree of epithelial hyperplasia without evidence of regression-inducing lentoid formation. These findings indicate that the advanced myopic ablation profile utilized in SmartSight treatments contributes to optimal postoperative stability and visual outcomes. Further research may aid in refining treatment algorithms to enhance the efficacy and predictability of laser-driven lenticule extraction procedures.
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.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
Marshall J, Trokel S, Rothery S, Krueger RR. A comparative study of corneal incisions induced by diamond and steel knives and two ultraviolet radiations from an excimer laser. Br J Ophthalmol. 1986;70(7):482–501. https://doi.org/10.1136/bjo.70.7.482.CrossRefPubMedPubMedCentral
Shah R, Shah S, Sengupta S. Results of small incision lenticule extraction: all-in-one femtosecond laser refractive surgery. J Cataract Refract Surg. 2011;37(1):127–37. https://doi.org/10.1016/j.jcrs.2010.07.033.CrossRefPubMed
Dausch D, Klein R, Schröder E, Dausch B. Excimer laser photorefractive keratectomy with tapered transition zone for high myopia. A preliminary report of six cases. J Cataract Refract Surg. 1993;19(5):590–4. https://doi.org/10.1016/s0886-3350(13)80005-3.CrossRefPubMed
Sedaghat MR, Momeni-Moghaddam H, Gazanchian M, et al. Corneal epithelial thickness mapping after photorefractive keratectomy for myopia. J Refract Surg. 2019;35(10):632–41. https://doi.org/10.3928/1081597X-20190826-03.CrossRefPubMed
10.
Spadea L, Fasciani R, Necozione S, Balestrazzi E. Role of the corneal epithelium in refractive changes following laser in situ keratomileusis for high myopia. J Refract Surg. 2000;16(2):133–9. https://doi.org/10.3928/1081-597X-20000301-05.CrossRefPubMed
11.
Reinstein DZ, Archer TJ, Gobbe M. Lenticule thickness readout for small incision lenticule extraction compared to Artemis three-dimensional very high-frequency digital ultrasound stromal measurements. J Refract Surg. 2014;30(5):304–9. https://doi.org/10.3928/1081597X-20140416-01.CrossRefPubMed
Ryu IH, Kim BJ, Lee JH, Kim SW. Comparison of corneal epithelial remodeling after femtosecond laser-assisted LASIK and small incision lenticule extraction (SMILE). J Refract Surg. 2017;33(4):250–6. https://doi.org/10.3928/1081597X-20170111-01.CrossRefPubMed
Savini G, Schiano-Lomoriello D, Hoffer KJ. Repeatability of automatic measurements by a new anterior segment optical coherence tomographer combined with Placido topography and agreement with 2 Scheimpflug cameras. J Cataract Refract Surg. 2018;44(4):471–8. https://doi.org/10.1016/j.jcrs.2018.02.015. CrossRefPubMed
17.
Gabric I, Bohac M, Gabric K, Arba MS. First European results of a new refractive lenticular extraction procedure-SmartSight by SCHWIND eye-tech-solutions. Eye (Lond). 2023;37(18):3768–75. https://doi.org/10.1038/s41433-023-02601-0. CrossRefPubMed
Vinciguerra P, Roberts CJ, Albé E, et al. Corneal curvature gradient map: a new corneal topography map to predict the corneal healing process. J Refract Surg. 2014;30(3):202–7. https://doi.org/10.3928/1081597X-20140218-02.CrossRefPubMed
20.
Gatinel D, Weyhausen A, Bischoff M. The percent volume altered in correction of myopia and myopic astigmatism with PRK, LASIK, and SMILE. J Refract Surg. 2020;36(12):844–50. https://doi.org/10.3928/1081597X-20200827-01.CrossRefPubMed
21.
Kang DSY, Lee H, Reinstein DZ, et al. Comparison of the distribution of lenticule decentration following SMILE by subjective patient fixation or triple marking centration. J Refract Surg. 2018;34(7):446–52. https://doi.org/10.3928/1081597X-20180517-02.CrossRefPubMed
22.
Arba Mosquera S, Ewering T. New asymmetric centration strategy combining pupil and corneal vertex information for ablation procedures in refractive surgery: theoretical background. J Refract Surg. 2012;28(8):567–73. https://doi.org/10.3928/1081597X-20120703-01. CrossRefPubMed
Vogel A, Capon MR, Asiyo-Vogel MN, Birngruber R. Intraocular photodisruption with picosecond and nanosecond laser pulses: tissue effects in cornea, lens, and retina. Invest Ophthalmol Vis Sci. 1994;35(7):3032–44.PubMed
28.
Shetty R, Shroff R, Kaweri L, Jayadev C, Kummelil MK, Sinha RA. Intra-operative cap repositioning in small incision lenticule extraction (SMILE) for enhanced visual recovery. Curr Eye Res. 2016;41(12):1532–8. https://doi.org/10.3109/02713683.2016.1168848.CrossRefPubMed
Wilson SE, Klyce SD, McDonald MB, Liu JC, Kaufman HE. Changes in corneal topography after excimer laser photorefractive keratectomy for myopia. Ophthalmology. 1991;98(9):1338–47. https://doi.org/10.1016/s0161-6420(91)32127-4.CrossRefPubMed
Luft N, Ring MH, Dirisamer M, et al. Corneal epithelial remodeling induced by small incision lenticule extraction (SMILE). Invest Ophthalmol Vis Sci. 2016;57(9):OCT176–83. https://doi.org/10.1167/iovs.15-18879.CrossRefPubMed
42.
Ganesh S, Brar S, Relekar KJ. Epithelial thickness profile changes following small incision refractive lenticule extraction (SMILE) for myopia and myopic astigmatism. J Refract Surg. 2016;32(7):473–82. https://doi.org/10.3928/1081597X-20160512-01.CrossRefPubMed
43.
Harvey MR, Rodrigues J, Lane JCE, Wade RG, Broekstra DC, Harrison C. Statistics for the hand surgeon. Part 2: avoiding common pitfalls. J Hand Surg Eur Vol. 2023;48(11):1237–43. https://doi.org/10.1177/17531934231200354. CrossRefPubMed
Ob und wie stark können Infektionen mit dem Respiratorischen Synzytial-Virus kardiorespiratorische Probleme auch in der postakuten Phase verursachen? Eine Studie hat das untersucht.
Eine opportunistische Eileiterentfernung reduziert das Risiko für tubo-ovarielle Karzinome um 40 bis 80% – ohne kurzfristige Nachteile für die Ovarialfunktion. Die Europäische Gynäkologievereinigung rät Frauen ohne Kinderwunsch daher, solche Eingriffe zu nutzen.
Haben Menschen mit einer chronischen Niereninsuffizienz nachts systolische Blutdruckwerte über 110 mmHg, scheint dies die Nierenfunktion weiter zu verschlechtern. Ab 65 Jahren ist es nach Daten aus China aber genau umgekehrt.
Die Behandlung eines Typ-2-Diabetes mit oralem Semaglutid scheint sich auch auf eine bestehende Herzinsuffizienz günstig auszuwirken. Laut einer Sekundäranalyse der SOUL-Studie profitieren vor allem Patienten und Patientinnen mit erhaltener Auswurffraktion.
