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Effect of Lowering Laser Energy on the Surface Roughness of Human Corneal Lenticules in SMILE

 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 
 Journal of Refractive Surgery, Vol.33(9) : 617-624, 2017 
Journal Title
 Journal of Refractive Surgery 
Issue Date
Adult ; Corneal Stroma/surgery ; Corneal Stroma/ultrastructure* ; Corneal Surgery, Laser/methods* ; Female ; Humans ; Lasers, Excimer/therapeutic use* ; Microscopy, Electron, Scanning ; Myopia/pathology ; Myopia/physiopathology ; Myopia/surgery* ; Refraction, Ocular/physiology* ; Treatment Outcome ; Young Adult
PURPOSE: To determine the effect of lowering femtosecond laser energy on the surface quality of the intrastromal interface during small incision lenticule extraction (SMILE). METHODS: Forty age- and diopter-matched female patients (40 eyes) with moderate myopia received SMILE with different energy levels (100 to 150 nJ) and fixed spot separation (4.5 μm). Five human corneal lenticules from each energy group were evaluated by atomic force microscopy and scanning electron microscopy (SEM). Both anterior and posterior surface characteristics of the lenticules were assessed. RESULTS: All measurements of surface roughness were approximately three times higher and in the anterior and posterior surface of the lenticules with the energy level of 150 nJ than with 100 nJ (P < .001). Furthermore, atomic force microscopy analysis found that energy differences of 15 nJ or more made a significant difference in surface roughness at energy levels of 115 nJ or higher. Interestingly, there was no significant difference in all roughness values of both surfaces among the 100, 105, and 110 nJ groups. In addition, all values of surface roughness were significantly positively correlated with laser energy for both anterior and posterior surfaces of the lenticule (P < .001). Consistent with atomic force microscopy results, SEM also showed that the SMILE lenticules in the higher laser energy group had more irregular surfaces. CONCLUSIONS: Lowering laser energy levels can improve surface quality of the lenticule of SMILE. To achieve better visual outcomes with faster recovery after the procedure, it is recommended to reduce the laser energy to less than 115 nJ at a spot separation of 4.5 μm.
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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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