12-Month Outcomes of Small Incision Lenticule Extraction With Proper Head Positioning but No Reference Marking for the Correction of Astigmatism

Abstract

Purpose: To investigate the 12-month outcomes of small incision lenticule extraction (SMILE) with proper head positioning but no reference marking for correcting astigmatism. Methods: This was a retrospective cohort study of 3,541 patients (5,953 eyes) who underwent SMILE between July 2010 and April 2021. Patient positioning on the treatment bed was meticulously done in every patient to avoid face turn, head tilt, and chin-up or chin-down posture. The corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction, astigmatic outcomes, and adverse events were evaluated at 1, 3, and 12 months postoperatively. Results: The mean preoperative manifest spherical equivalent and manifest cylinder were −5.15 ± 2.24 diopters (D) (range: −0.13 to −12.88 D) and −1.00 ± 0.77 D (range: −0.25 and −6.00 D), respectively. Of all eyes, 88.4% and 98.6% had the spherical equivalent within ±0.50 and ±1.00 D of emmetropia at 12 months. The percentage of eyes with UDVA of 20/20 or better was 92.5%. Six eyes (0.1%) lost two or more lines of CDVA at the 12-month visit. The predictability of cylinder correction was excellent, with 88.1% within ±0.50 D and 98.9% within ± 1.00 D of astigmatism correction at 12 months. The mean correction index (CI) at 12 months was 1.09 ± 0.45 (range: 0.17 to 4.99), indicating a slight astigmatism overcorrection. The high cylinder group tended to have undercorrection with greater residual astigmatism, whereas the low cylinder group was likely to have overcorrection with lesser residual astigmatism ( P < .001). No serious adverse events were observed. Conclusions: SMILE with proper head positioning but no reference marking produces safe, efficient, predictable, and stable outcomes for astigmatism correction over a 12-month period. [ J Refract Surg . 2023;39(10):683–692.]