Clinical Ophthalmology (Sep 2022)
Photorefractive Keratectomy Enhancement (PRK) After Small-Incision Lenticule Extraction (SMILE)
Abstract
Majid Moshirfar,1– 3 Mark T Parsons,4 Nicholas A Chartrand,4 Chap-Kay Lau,4 Seth Stapley,5 Nour Bundogji,2 Yasmyne C Ronquillo,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA; 5Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USACorrespondence: Majid Moshirfar, Hoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT, 84020, USA, Tel +1 801-568-0200, Fax +1 801-563-0200, Email [email protected]: To determine rates of enhancement and visual prognosis following photorefractive keratectomy (PRK) enhancement of small-incision lenticule extraction (SMILE).Patients and Methods: This retrospective, single-site study reviewed all cases of primary SMILE at Hoopes Vision in Draper, Utah between March 14, 2017 and April 8, 2022 to identify any cases that required follow-up enhancement. Primary SMILE was performed using Visumax 500 kHz femtosecond laser (Carl Zeiss Meditec, Jena, Germany). All enhancements were performed with alcohol-assisted PRK, using a WaveLight EX500 excimer laser (Alcon Laboratories, Inc., Fort Worth, TX).Results: Four hundred and five eyes underwent primary SMILE, of which 15 later underwent PRK enhancement (enhancement rate of 3.7%). No significant difference in pre-SMILE data was identified between the enhancement and non-enhancement groups. The average age of those who underwent PRK enhancement was 33.8± 6.3 years old and ranged from 25 to 45. Following primary SMILE, 13 eyes (87%) had an uncorrected distance visual acuity (UDVA) of 20/40 or better, and none had a UDVA of 20/20 or better. After one year of post-enhancement follow-up, all eyes had a UDVA of 20/40 or better, and 13 eyes (87%) had a UDVA of 20/20 or better (Figure 1). All were within one diopter of target spherical equivalent (SEQ), 13 (87%) were within 0.50 D, and 10 (67%) were within 0.25 D. Of those with 12-month follow-up data, none had UDVA worse than corrected distance visual acuity (CDVA), and none had lost lines of CDVA. Efficacy and safety indices were 1.03 and 0.99, respectively.Conclusion: Following SMILE, ophthalmologists may anticipate an enhancement rate of one to seven percent. In these cases, PRK is a safe and effective procedure for enhancement of SMILE.Keywords: retreatment, LASIK, refractive surgery, myopia, astigmatism, SMILE
