Epithelial-related complications more prevalent in older patients after recovery from SMILE
Small incision lenticule extraction (SMILE) is a laser refractive surgery to correct myopia. Using a femtosecond laser, a small intrastromal lenticule is created and manually extracted through a small incision. Unlike other refractive surgical techniques, SMILE does not involve the creation of a corneal flap, providing several advantages over laser assisted in situ keratomileusis (LASIK) with respect to managing postoperative corneal-related complications. Although epithelial-related complications after LASIK have been described in several studies, the incidence of epithelial-related complications following SMILE is not as well documented. The study by Moshirfar et al reported a single-site five-year experience with the incidence and management of only epithelial-related complications after SMILE.
A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups.
Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye).
There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001).
Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001).
However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively).
There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively).
In this retrospective chart review, various epithelial-related complications following SMILE were analyzed. Of the 10 complication groups, these four were the most cited: interface debris, rough epithelium, epithelial defect, and epithelial ingrowth.
This study examined the incidence and management of epithelial-related complications after SMILE. Despite the development of such complications, satisfactory visual prognoses could be achieved with various strategies. The study found that epithelial-related complications were more prevalent in older patients and predisposed patients to require future PRK enhancements after recovery from SMILE.
Source: Moshirfar et al; Clinical Ophthalmology 2023:17 2777–2789
