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Lower Laser Energy Levels Lead to Better Visual Recovery After Small-Incision Lenticule Extraction: Prospective Randomized Clinical Trial

 Yong Woo Ji  ;  Minseo Kim  ;  David Sung Yong Kang  ;  Dan Z. Reinstein  ;  Timothy J. Archer  ;  Jin Young Choi  ;  Eung Kweon Kim  ;  Hyung Keun Lee  ;  Kyoung Yul Seo  ;  Tae-im Kim 
 American Journal of Ophthalmology, Vol.179 : 159-170, 2017 
Journal Title
 American Journal of Ophthalmology 
Issue Date
Adult ; Astigmatism/physiopathology ; Astigmatism/surgery* ; Corneal Stroma/surgery* ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ/methods* ; Lasers, Excimer/therapeutic use* ; Male ; Myopia/physiopathology ; Myopia/surgery* ; Postoperative Period ; Prospective Studies ; Recovery of Function/physiology* ; Refraction, Ocular/physiology* ; Treatment Outcome ; Young Adult
PURPOSE: To determine the effect of lowering laser energy on clinical outcomes in small-incision lenticule extraction (SMILE). DESIGN: Prospective randomized clinical trial. METHODS: A total of 151 patients (151 eyes) with moderate myopia scheduled for SMILE were included: 58 eyes received SMILE with low energy (100, 105, and 110 nJ; L-SMILE group) and 93 with conventional energy (115-150 nJ; C-SMILE group). Patients received complete ophthalmic examinations preoperatively and over 3 months postoperatively. RESULTS: Uncorrected distance visual acuity (logMAR UDVA) 1 day and 1 week postoperatively was significantly better in L-SMILE than in C-SMILE (P < .001 and P = .005, respectively). There was no significant difference between the groups at 1 and 3 months. L-SMILE induced significantly fewer corneal aberrations compared with C-SMILE at 1 week and 1 month postoperatively (both P < .01), but there were no significant differences at 3 months. Though there was no difference in logMAR UDVA over the postoperative period between the 100, 105, and 110 nJ subgroups, there was a significant difference in logMAR UDVA on postoperative day 1 between L-SMILE and each subgroup in which an energy level of 115 nJ or higher was used. Furthermore, logMAR UDVA on postoperative day 1 showed a significant correlation with laser energy (r = 0.451, P < .001) and multiple linear regression analysis revealed that energy level was the only independent factor associated with logMAR UDVA on postoperative day 1 (P < .001). CONCLUSIONS: SMILE using femtosecond energy of less than 115 nJ facilitates better visual acuity with less induction of corneal aberrations in the early postoperative period.
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1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
김응권(Kim, Eung Kweon) ORCID logo https://orcid.org/0000-0002-1453-8042
김태임(Kim, Tae Im) ORCID logo https://orcid.org/0000-0001-6414-3842
서경률(Seo, Kyuong Yul) ORCID logo https://orcid.org/0000-0002-9855-1980
이형근(Lee, Hyung Keun) ORCID logo https://orcid.org/0000-0002-1123-2136
지용우(Ji, Yong Woo)
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