Ectasia following small-incision lenticule extraction (SMILE): a review of the literature

Majid Moshirfar,1,2 Julio C Albarracin,3 Jordan D Desautels,1,4 Orry C Birdsong,1 Steven H Linn,1 Phillip C Hoopes Sr1 1HDR Research Center, Hoopes Vision, Draper, 2John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 3...

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Autores principales:	Moshirfar M, Albarracin JC, Desautels JD, Birdsong OC, Linn SH, Hoopes Sr PC
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	SMILE Small incision Lenticule Extraction Ectasia Keratoconus Percent Tissue Altered Ectasia Risk Score System Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/16de510c23c44603b203d145c7ee70f6
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spelling	oai:doaj.org-article:16de510c23c44603b203d145c7ee70f62021-12-02T07:34:15ZEctasia following small-incision lenticule extraction (SMILE): a review of the literature1177-5483https://doaj.org/article/16de510c23c44603b203d145c7ee70f62017-09-01T00:00:00Zhttps://www.dovepress.com/ectasia-following-small-incision-lenticule-extraction-smile-a-review-o-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Majid Moshirfar,1,2 Julio C Albarracin,3 Jordan D Desautels,1,4 Orry C Birdsong,1 Steven H Linn,1 Phillip C Hoopes Sr1 1HDR Research Center, Hoopes Vision, Draper, 2John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 3Department of Ophthalmology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 4Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA Purpose: Four cases of corneal ectasia after small-incision lenticule extraction (SMILE) have been reported. In this review, we provide an overview of the published literature on corneal ectasia after SMILE and risk factors associated with this complication.Methods: Case reports were identified by a search of seven electronic databases for pertinent heading terms between 2011 and July 2017. We identified patient characteristics and surgical details including preoperative topography, central corneal thickness, and anterior keratometry (Km). Residual stromal bed (RSB) values not reported were computed using VisuMax ReLEx SMILE software Version 2.10.10. Preoperative ectasia risk was measured using the Randleman Ectasia Risk Score System (ERSS). Percent tissue alteration was calculated for each patient as described by Santhiago et al.Results: Seven eyes of four patients developed corneal ectasia post SMILE. Two patients had abnormal topography in both eyes. One patient had abnormal topography in one eye. Only one patient was noted to have normal topography in both eyes and later developed ectasia in one eye in the absence of any known risk factors. The mean Randleman ectasia risk score was 4±3 (range: 1–8). The mean calculated percent tissue altered (PTA) was 38%±6% (range: 30%–47%).Conclusion: A majority of reported ectasia cases occurred in patients with subclinical keratoconus. These conditions may be exacerbated by SMILE and should be considered absolute contraindications to the procedure. Three patients were identified to have high risk based on the ERSS, and one patient exhibited a PTA ≥40%. We formulated a modification to the current calculation of PTA that takes into account the differences in tissue altered between SMILE and laser in situ keratomileusis (LASIK). More studies are needed to fully quantify the risk of ectasia. For now, we propose adopting the same exclusion criteria used for LASIK in the SMILE procedure until more specific metrics have been validated. Keywords: SMILE, small-incision lenticule extraction, ectasia, keratoconus, percent tissue altered, Ectasia Risk Score SystemMoshirfar MAlbarracin JCDesautels JDBirdsong OCLinn SHHoopes Sr PCDove Medical PressarticleSMILESmall incision Lenticule ExtractionEctasiaKeratoconusPercent Tissue AlteredEctasia Risk Score SystemOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 11, Pp 1683-1688 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	SMILE Small incision Lenticule Extraction Ectasia Keratoconus Percent Tissue Altered Ectasia Risk Score System Ophthalmology RE1-994
spellingShingle	SMILE Small incision Lenticule Extraction Ectasia Keratoconus Percent Tissue Altered Ectasia Risk Score System Ophthalmology RE1-994 Moshirfar M Albarracin JC Desautels JD Birdsong OC Linn SH Hoopes Sr PC Ectasia following small-incision lenticule extraction (SMILE): a review of the literature
description	Majid Moshirfar,1,2 Julio C Albarracin,3 Jordan D Desautels,1,4 Orry C Birdsong,1 Steven H Linn,1 Phillip C Hoopes Sr1 1HDR Research Center, Hoopes Vision, Draper, 2John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 3Department of Ophthalmology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, 4Department of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA Purpose: Four cases of corneal ectasia after small-incision lenticule extraction (SMILE) have been reported. In this review, we provide an overview of the published literature on corneal ectasia after SMILE and risk factors associated with this complication.Methods: Case reports were identified by a search of seven electronic databases for pertinent heading terms between 2011 and July 2017. We identified patient characteristics and surgical details including preoperative topography, central corneal thickness, and anterior keratometry (Km). Residual stromal bed (RSB) values not reported were computed using VisuMax ReLEx SMILE software Version 2.10.10. Preoperative ectasia risk was measured using the Randleman Ectasia Risk Score System (ERSS). Percent tissue alteration was calculated for each patient as described by Santhiago et al.Results: Seven eyes of four patients developed corneal ectasia post SMILE. Two patients had abnormal topography in both eyes. One patient had abnormal topography in one eye. Only one patient was noted to have normal topography in both eyes and later developed ectasia in one eye in the absence of any known risk factors. The mean Randleman ectasia risk score was 4±3 (range: 1–8). The mean calculated percent tissue altered (PTA) was 38%±6% (range: 30%–47%).Conclusion: A majority of reported ectasia cases occurred in patients with subclinical keratoconus. These conditions may be exacerbated by SMILE and should be considered absolute contraindications to the procedure. Three patients were identified to have high risk based on the ERSS, and one patient exhibited a PTA ≥40%. We formulated a modification to the current calculation of PTA that takes into account the differences in tissue altered between SMILE and laser in situ keratomileusis (LASIK). More studies are needed to fully quantify the risk of ectasia. For now, we propose adopting the same exclusion criteria used for LASIK in the SMILE procedure until more specific metrics have been validated. Keywords: SMILE, small-incision lenticule extraction, ectasia, keratoconus, percent tissue altered, Ectasia Risk Score System
format	article
author	Moshirfar M Albarracin JC Desautels JD Birdsong OC Linn SH Hoopes Sr PC
author_facet	Moshirfar M Albarracin JC Desautels JD Birdsong OC Linn SH Hoopes Sr PC
author_sort	Moshirfar M
title	Ectasia following small-incision lenticule extraction (SMILE): a review of the literature
title_short	Ectasia following small-incision lenticule extraction (SMILE): a review of the literature
title_full	Ectasia following small-incision lenticule extraction (SMILE): a review of the literature
title_fullStr	Ectasia following small-incision lenticule extraction (SMILE): a review of the literature
title_full_unstemmed	Ectasia following small-incision lenticule extraction (SMILE): a review of the literature
title_sort	ectasia following small-incision lenticule extraction (smile): a review of the literature
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/16de510c23c44603b203d145c7ee70f6
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Ectasia following small-incision lenticule extraction (SMILE): a review of the literature

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