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Comparison of clinical outcomes between vector planning and manifest refraction planning in SMILE for myopic astigmatism

 Ikhyun Jun  ;  David Sung Yong Kang  ;  Samuel Arba-Mosquera  ;  Dan Z Reinstein  ;  Timothy J Archer  ;  Seung Ki Jean  ;  Eung Kweon Kim  ;  Kyoung Yul Seo  ;  Hyung Keun Lee  ;  Tae-Im Kim 
 JOURNAL OF CATARACT AND REFRACTIVE SURGERY, Vol.46(8) : 1149-1158, 2020-08 
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Purpose: To compare clinical outcomes of small-incision lenticule extraction (SMILE) between manifest refraction (MR) and vector planning for myopic astigmatism with high ocular residual astigmatism (ORA). Setting: Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. Design: Prospective, randomized, comparative case series. Methods: Patients with myopic astigmatism and ORA of 0.75 diopters (D) or greater were randomized into the MR or vector planning group and underwent SMILE without applying any nomogram for cylinder correction. Visual acuity, MR, corneal topography, and corneal aberration were measured preoperatively and postoperatively. Outcomes at 6 months postoperatively were compared between the groups. Results: The study comprised 114 patients (114 eyes): 58 eyes in MR planning and 56 eyes in vector planning. The mean uncorrected and corrected distance visual acuity, safety and efficacy indices were comparable between the 2 groups. Postoperative refractive cylinder reached statistically significant differences between the groups (-0.22 ± 0.18 D and -0.14 ± 0.16 D in the MR and vector planning groups, respectively, P = .02). Postoperative corneal toricity and ORA reached statistically significant lower in the vector planning group. Conclusions: In myopic astigmatism with high ORA, MR and vector planning in SMILE were effective with comparable visual outcomes; vector planning showed statistically significant lower postoperative refractive and corneal astigmatism and ORA. Use of vector planning may improve refractive outcomes in SMILE cases with high ORA. However, the results may have been different had a nomogram adjustment been applied, as is often used for cylinder corrections with SMILE.
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1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Eung Kweon(김응권) ORCID logo https://orcid.org/0000-0002-1453-8042
Kim, Tae Im(김태임) ORCID logo https://orcid.org/0000-0001-6414-3842
Seo, Kyoung Yul(서경률) ORCID logo https://orcid.org/0000-0002-9855-1980
Lee, Hyung Keun(이형근) ORCID logo https://orcid.org/0000-0002-1123-2136
Jun, Ik Hyun(전익현) ORCID logo https://orcid.org/0000-0002-2160-1679
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