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Effect of Intraoperative Corneal Stromal Pocket Irrigation in Small Incision Lenticule Extraction.

Liu YC, Jayasinghe L, Ang HP, Lwin NC, Yam GH, Mehta JS - Biomed Res Int (2015)

Bottom Line: This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK).The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness.Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required.

View Article: PubMed Central - PubMed

Affiliation: Singapore Eye Research Institute, Singapore ; Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751.

ABSTRACT
This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Sixteen rabbit eyes underwent a SMILE procedure, with 8 eyes having corneal pocket irrigation, while the other 8 eyes were without irrigation. Another 16 eyes underwent a FS-LASIK procedure for comparison, with 8 eyes having flap irrigation, while the other 8 eyes were without irrigation. The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness. However, at postoperative 8 hours, in vivo confocal microscopy showed that the interface reflectivity in the SMILE with irrigation group was significantly higher than that in other three groups. The presence of interface fluid was further confirmed by the identification of fluid pockets with undulated collagen shown on histological section in the post-SMILE with irrigation eyes. Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required.

No MeSH data available.


Representative in vivo confocal images at the extracted lenticule plane (SMILE with and without irrigation groups) and at the flap interface (LASIK with and without irrigation groups) at different time points. These interface layers were acellular and were characterized by light-scattering particles. Inset images showed the plane adjacent to the extracted lenticule plane or flap interface. Highly reflective keratocytes were observed in these planes.
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fig3: Representative in vivo confocal images at the extracted lenticule plane (SMILE with and without irrigation groups) and at the flap interface (LASIK with and without irrigation groups) at different time points. These interface layers were acellular and were characterized by light-scattering particles. Inset images showed the plane adjacent to the extracted lenticule plane or flap interface. Highly reflective keratocytes were observed in these planes.

Mentions: Highly reflective keratocytes were observed in the stromal layer directly anterior and posterior to the excimer laser ablation plane in the post-LASIK eyes or to the extracted lenticule plane in the post-SMILE eyes. The keratocytes were observed in similar density in all corneas. The flap interface and extracted lenticule plane were acellular and characterized by light-scattering particles (Figure 3). Semiquantitative analysis of the reflectivity was performed. The reflectivity in the four groups was comparable within the first 4 hours (P = 0.693 and P = 0.745, resp., immediately after surgery and 4 hours postoperatively). Immediately after surgery, post-FS-LASIK eyes (with irrigation or without irrigation) had higher reflectivity than post-SMILE eyes (with irrigation or without irrigation), although the difference was not statistically significant. At postoperative 8 hours, the eyes that underwent SMILE with irrigation had significantly higher reflectivity than those which underwent FS-LASIK with irrigation, FS-LASIK without irrigation, and SMILE without irrigation (P = 0.047, P = 0.041, and P = 0.005, resp.). The reflectivity decreased gradually thereafter. At postoperative 24 hours, the reflectivity decreased by 33.1%, 40.6%, 42.7%, and 21.4%, respectively, in the FS-LASIK with irrigation, FS-LASIK without irrigation, SMILE without irrigation, and SMILE with irrigation groups, when compared to that immediately after surgery (P = 0.019, P = 0.046, and P = 0.116, resp.). At 24 hours, the reflectivity difference among different groups was not statistically significant (P = 0.083; Figure 4).


Effect of Intraoperative Corneal Stromal Pocket Irrigation in Small Incision Lenticule Extraction.

Liu YC, Jayasinghe L, Ang HP, Lwin NC, Yam GH, Mehta JS - Biomed Res Int (2015)

Representative in vivo confocal images at the extracted lenticule plane (SMILE with and without irrigation groups) and at the flap interface (LASIK with and without irrigation groups) at different time points. These interface layers were acellular and were characterized by light-scattering particles. Inset images showed the plane adjacent to the extracted lenticule plane or flap interface. Highly reflective keratocytes were observed in these planes.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4530243&req=5

fig3: Representative in vivo confocal images at the extracted lenticule plane (SMILE with and without irrigation groups) and at the flap interface (LASIK with and without irrigation groups) at different time points. These interface layers were acellular and were characterized by light-scattering particles. Inset images showed the plane adjacent to the extracted lenticule plane or flap interface. Highly reflective keratocytes were observed in these planes.
Mentions: Highly reflective keratocytes were observed in the stromal layer directly anterior and posterior to the excimer laser ablation plane in the post-LASIK eyes or to the extracted lenticule plane in the post-SMILE eyes. The keratocytes were observed in similar density in all corneas. The flap interface and extracted lenticule plane were acellular and characterized by light-scattering particles (Figure 3). Semiquantitative analysis of the reflectivity was performed. The reflectivity in the four groups was comparable within the first 4 hours (P = 0.693 and P = 0.745, resp., immediately after surgery and 4 hours postoperatively). Immediately after surgery, post-FS-LASIK eyes (with irrigation or without irrigation) had higher reflectivity than post-SMILE eyes (with irrigation or without irrigation), although the difference was not statistically significant. At postoperative 8 hours, the eyes that underwent SMILE with irrigation had significantly higher reflectivity than those which underwent FS-LASIK with irrigation, FS-LASIK without irrigation, and SMILE without irrigation (P = 0.047, P = 0.041, and P = 0.005, resp.). The reflectivity decreased gradually thereafter. At postoperative 24 hours, the reflectivity decreased by 33.1%, 40.6%, 42.7%, and 21.4%, respectively, in the FS-LASIK with irrigation, FS-LASIK without irrigation, SMILE without irrigation, and SMILE with irrigation groups, when compared to that immediately after surgery (P = 0.019, P = 0.046, and P = 0.116, resp.). At 24 hours, the reflectivity difference among different groups was not statistically significant (P = 0.083; Figure 4).

Bottom Line: This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK).The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness.Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required.

View Article: PubMed Central - PubMed

Affiliation: Singapore Eye Research Institute, Singapore ; Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751.

ABSTRACT
This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Sixteen rabbit eyes underwent a SMILE procedure, with 8 eyes having corneal pocket irrigation, while the other 8 eyes were without irrigation. Another 16 eyes underwent a FS-LASIK procedure for comparison, with 8 eyes having flap irrigation, while the other 8 eyes were without irrigation. The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness. However, at postoperative 8 hours, in vivo confocal microscopy showed that the interface reflectivity in the SMILE with irrigation group was significantly higher than that in other three groups. The presence of interface fluid was further confirmed by the identification of fluid pockets with undulated collagen shown on histological section in the post-SMILE with irrigation eyes. Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required.

No MeSH data available.