Mathematical modeling of the refractive effect of SMILE surgery in high degree myopia correction

Abstract

The aim of the study. To develop a mathematical model of changes in corneal refraction during femtosecond laser-assisted lenticule extraction through a small surgical incision and, on this basis, to propose a technology for modified calculation of surgical parameters and to prove its effectiveness. Material and methods. The study included 191 patients with high myopia. They were divided into two groups: group  1 consisted of 55  patients who  were  had  SMILE (SMall Incision Lenticule Extraction) surgery with standard calculations; group  2 included 136 patients who had SMILE surgery with a modified calculation of surgical parameters based on the developed mathematical model of the refractive effect of the surgery. Results. When assessing the refractive effect of patients who were operated using standard technology, it was found that it was possible to achieve a refraction different from emmetropia for ± 0.5 D only in 51 % of cases; in the remaining patients, the planned residual refractive effect was obtained and averaged –1.96 ± 0.29 D. In patients operated using the modified technology, a statistically significantly better refractive result was achieved already on the first day. A refractive error of more than ± 1.0 D was obtained in only 1 % of cases; a deviation from the calculated refraction of ± 0.5 D was achieved in 82 % of cases, with the average values by 1 year –0.24 ± 0.57 D. Conclusions. The developed technology of a modified calculation of the parameters of the SMILE surgery for high myopia correction makes it possible to obtain an optimal refractive effect in compliance with safety rules when the structural and functional parameters of the eye are initially unfavorable for refractive surgery.