Skip to main content
Top
Published in: International Ophthalmology 5/2018

01-10-2018 | Original Paper

Corneal thickness, residual stromal thickness, and its effect on opaque bubble layer in small-incision lenticule extraction

Authors: Jiaonan Ma, Yan Wang, Liuyang Li, Jiamei Zhang

Published in: International Ophthalmology | Issue 5/2018

Login to get access

Abstract

Purpose

To evaluate the effects of the central corneal thickness (CCT) and residual stromal thickness (RST) on the formation of opaque bubble layer (OBL) during small-incision lenticule extraction (SMILE).

Methods

A total of 345 eyes from Refractive Surgery Center database at Tianjin Eye Hospital that had been subjected to SMILE surgery and followed for 6 months were included in this study and divided into OBL and OBL-free groups. Preoperative, intraoperative, and postoperative data for all eyes were evaluated and analyzed using multivariate regression analysis. After adjustment for several confounding factors, potential associations of CCT and RST with OBL were elucidated by determining odds ratios (ORs) and 95% confidence intervals (CIs).

Results

In total, 22 of the 345 eyes developed various degrees of OBL during the femtosecond laser scanning phase of SMILE surgery. After adjustment for age, sex, and refractive errors, significant relationships were detected between CCT and RST and OBL formation (OR 1.04; 95% CI 1.02–1.06; OR 1.03; 95% CI 1.02–1.05, respectively, P < 0.001). Smooth curve fitting revealed an increased risk of OBL in the presence of an increased CCT or RST. However, visual outcomes were comparable between the two groups at both 3 and 6 months postoperatively.

Conclusions

The results suggest that OBL formation during SMILE surgery is more likely in eyes with a thicker cornea. CCT and RST can be considered independent risk factors for OBL formation. Although this phenomenon may disturb the surgical procedure, it is unlikely to affect the postoperative visual outcome.
Literature
1.
go back to reference Juhasz T, Loesel FH, Kurtz RM, Horvath C (1999) Corneal refractive surgery with femtosecond lasers. IEEE J Sel Top Quantum Electron 5:902–910CrossRef Juhasz T, Loesel FH, Kurtz RM, Horvath C (1999) Corneal refractive surgery with femtosecond lasers. IEEE J Sel Top Quantum Electron 5:902–910CrossRef
2.
go back to reference Vestergaard AH, Grauslund J, Ivarsen AR, Hjortdal JØ (2014) Efficacy, safety, predictability, contrast sensitivity, and aberrations after femtosecond laser lenticule extraction. J Cataract Refract Surg 40:403–411CrossRefPubMed Vestergaard AH, Grauslund J, Ivarsen AR, Hjortdal JØ (2014) Efficacy, safety, predictability, contrast sensitivity, and aberrations after femtosecond laser lenticule extraction. J Cataract Refract Surg 40:403–411CrossRefPubMed
3.
go back to reference Tian H, Ke Z, Chen Y, Yang G, Li H, Zhou X (2016) Four-year observation of predictability and stability of small incision lenticule extraction. BMC Ophthalmol 16:149CrossRef Tian H, Ke Z, Chen Y, Yang G, Li H, Zhou X (2016) Four-year observation of predictability and stability of small incision lenticule extraction. BMC Ophthalmol 16:149CrossRef
4.
go back to reference Zhang Y, Shen Q, Jia Y, Zhou D, Zhou J (2016) Clinical outcomes of smile and FS-LASIK used to treat myopia: a meta-analysis. J Refract Surg 32:256–265CrossRefPubMed Zhang Y, Shen Q, Jia Y, Zhou D, Zhou J (2016) Clinical outcomes of smile and FS-LASIK used to treat myopia: a meta-analysis. J Refract Surg 32:256–265CrossRefPubMed
5.
go back to reference Reinstein DZ, Archer TJ, Gobbe M (2013) Accuracy and reproducibility of cap thickness in small incision lenticule extraction. J Refract Surg 29:810–818CrossRefPubMed Reinstein DZ, Archer TJ, Gobbe M (2013) Accuracy and reproducibility of cap thickness in small incision lenticule extraction. J Refract Surg 29:810–818CrossRefPubMed
6.
go back to reference Reinstein DZ, Gobbe M, Gobbe L, Archer TJ, Carp GI (2015) Optical zone centration accuracy using corneal fixation-based SMILE compared to eye tracker-based femtosecond laser-assisted LASIK for myopia. J Refract Surg 31:586–592CrossRefPubMed Reinstein DZ, Gobbe M, Gobbe L, Archer TJ, Carp GI (2015) Optical zone centration accuracy using corneal fixation-based SMILE compared to eye tracker-based femtosecond laser-assisted LASIK for myopia. J Refract Surg 31:586–592CrossRefPubMed
7.
go back to reference Aristeidou A, Taniguchi EV, Tsatsos M, Muller R, Mcalinden C, Pineda R (2015) The evolution of corneal and refractive surgery with the femtosecond laser. Eye Vis 2:1–14CrossRef Aristeidou A, Taniguchi EV, Tsatsos M, Muller R, Mcalinden C, Pineda R (2015) The evolution of corneal and refractive surgery with the femtosecond laser. Eye Vis 2:1–14CrossRef
8.
go back to reference Ratkay-Traub I, Ferincz IE, Juhasz T, Kurtz RM, Krueger RR (2003) First clinical results with the femtosecond neodynium-glass laser in refractive surgery. J Refract Surg 19:94–103PubMed Ratkay-Traub I, Ferincz IE, Juhasz T, Kurtz RM, Krueger RR (2003) First clinical results with the femtosecond neodynium-glass laser in refractive surgery. J Refract Surg 19:94–103PubMed
9.
go back to reference Luengo Gimeno F, Chan CM, Li L, Tan DT, Mehta JS (2011) Comparison of eye-tracking success in laser in situ keratomileusis after flap creation with 2 femtosecond laser models. J Cataract Refract Surg 37:538–543CrossRefPubMed Luengo Gimeno F, Chan CM, Li L, Tan DT, Mehta JS (2011) Comparison of eye-tracking success in laser in situ keratomileusis after flap creation with 2 femtosecond laser models. J Cataract Refract Surg 37:538–543CrossRefPubMed
10.
go back to reference Ide T, Yoo SH, Kymionis GD, Haft P, O’Brien TP (2009) Second femtosecond laser pass for incomplete laser in situ keratomileusis flaps caused by suction loss. J Cataract Refract Surg 35:153–157CrossRefPubMed Ide T, Yoo SH, Kymionis GD, Haft P, O’Brien TP (2009) Second femtosecond laser pass for incomplete laser in situ keratomileusis flaps caused by suction loss. J Cataract Refract Surg 35:153–157CrossRefPubMed
11.
go back to reference Ide T, Kymionis GD, Goldman DA, Yoo SH, O’Brien TP (2008) Subconjunctival gas bubble Formation during LASIK flap creation using femtosecond laser. J Refract Surg 24:850–851PubMed Ide T, Kymionis GD, Goldman DA, Yoo SH, O’Brien TP (2008) Subconjunctival gas bubble Formation during LASIK flap creation using femtosecond laser. J Refract Surg 24:850–851PubMed
13.
go back to reference Srinivasan S, Rootman DS (2007) Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK. J Refract Surg 23:828–830PubMed Srinivasan S, Rootman DS (2007) Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK. J Refract Surg 23:828–830PubMed
14.
go back to reference Kaiserman I, Maresky HS, Bahar I, Rootman DS (2008) Incidence, possible risk factors, and potential effects of an opaque bubble layer created by a femtosecond laser. J Cataract Refract Surg 34:417–423CrossRefPubMed Kaiserman I, Maresky HS, Bahar I, Rootman DS (2008) Incidence, possible risk factors, and potential effects of an opaque bubble layer created by a femtosecond laser. J Cataract Refract Surg 34:417–423CrossRefPubMed
15.
go back to reference Liu CH, Sun CC, Huikang MD, Chienchieh HJ, Liu CF, Chen HF (2014) Opaque bubble layer: incidence, risk factors, and clinical relevance. J Cataract Refract Surg 40:435–440CrossRefPubMed Liu CH, Sun CC, Huikang MD, Chienchieh HJ, Liu CF, Chen HF (2014) Opaque bubble layer: incidence, risk factors, and clinical relevance. J Cataract Refract Surg 40:435–440CrossRefPubMed
16.
go back to reference Jung HG, Kim J, Lim TH (2015) Possible risk factors and clinical effects of an opaque bubble layer created with femtosecond laser-assisted laser in situ keratomileusis. J Cataract Refract Surg 41:1393–1399CrossRefPubMed Jung HG, Kim J, Lim TH (2015) Possible risk factors and clinical effects of an opaque bubble layer created with femtosecond laser-assisted laser in situ keratomileusis. J Cataract Refract Surg 41:1393–1399CrossRefPubMed
17.
go back to reference Courtin R, Saad A, Guilbert E, Grise-Dulac A, Gatinel D (2015) Opaque bubble layer risk factors in femtosecond laser-assisted LASIK. J Refract Surg 31:608–612CrossRefPubMed Courtin R, Saad A, Guilbert E, Grise-Dulac A, Gatinel D (2015) Opaque bubble layer risk factors in femtosecond laser-assisted LASIK. J Refract Surg 31:608–612CrossRefPubMed
18.
go back to reference Son G, Lee J, Jang C, Choi KY, Cho BJ, Lim TH (2017) Possible risk factors and clinical effects of opaque bubble layer in small incision lenticule extraction (SMILE). J Refract Surg 33:24–29CrossRefPubMed Son G, Lee J, Jang C, Choi KY, Cho BJ, Lim TH (2017) Possible risk factors and clinical effects of opaque bubble layer in small incision lenticule extraction (SMILE). J Refract Surg 33:24–29CrossRefPubMed
19.
go back to reference Liu M, Zhou Y, Wu X, Ye T, Liu Q (2016) Comparison of 120- and 140-μm SMILE cap thickness results in eyes with thick corneas. Cornea 35:1CrossRef Liu M, Zhou Y, Wu X, Ye T, Liu Q (2016) Comparison of 120- and 140-μm SMILE cap thickness results in eyes with thick corneas. Cornea 35:1CrossRef
20.
21.
go back to reference Shah R, Shah S (2011) Effect of scanning patterns on the results of femtosecond laser lenticule extraction refractive surgery. J Cataract Refract Surg 37:1636–1647CrossRefPubMed Shah R, Shah S (2011) Effect of scanning patterns on the results of femtosecond laser lenticule extraction refractive surgery. J Cataract Refract Surg 37:1636–1647CrossRefPubMed
22.
go back to reference Hamed AM, Fekry AY (2016) Refractive small-incision lenticule extraction: push-up and push-down techniques. J Cataract Refract Surg 42:1713–1715CrossRefPubMed Hamed AM, Fekry AY (2016) Refractive small-incision lenticule extraction: push-up and push-down techniques. J Cataract Refract Surg 42:1713–1715CrossRefPubMed
23.
go back to reference Jacob S, Nariani A, Figus M, Agarwal A, Agarwal A (2016) White ring sign for uneventful lenticule separation in small-incision lenticule extraction. J Cataract Refract Surg 42:1251–1254CrossRefPubMed Jacob S, Nariani A, Figus M, Agarwal A, Agarwal A (2016) White ring sign for uneventful lenticule separation in small-incision lenticule extraction. J Cataract Refract Surg 42:1251–1254CrossRefPubMed
24.
go back to reference Wang Y, Dou R (2015) The effect of corneal biomechanics of the OBL during SMILE. Cataract Refract Surg Today Eur March:1–3 Wang Y, Dou R (2015) The effect of corneal biomechanics of the OBL during SMILE. Cataract Refract Surg Today Eur March:1–3
Metadata
Title
Corneal thickness, residual stromal thickness, and its effect on opaque bubble layer in small-incision lenticule extraction
Authors
Jiaonan Ma
Yan Wang
Liuyang Li
Jiamei Zhang
Publication date
01-10-2018
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 5/2018
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-017-0692-2

Other articles of this Issue 5/2018

International Ophthalmology 5/2018 Go to the issue