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[Impact of Different Percent Tissue Altered Values on Visual Outcome after Refractive Small Incision Lenticule

D R H Breyer1, P Hagen1, H Kaymak1

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Summary

ReLEx SMILE treatment is safe and effective for high percent tissue altered (PTA) values. This study found no evidence of keratectasia in eyes with PTA of 40% or more after three years.

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Area of Science:

  • Ophthalmology
  • Refractive Surgery
  • Corneal Surgery

Background:

  • ReLEx SMILE is a popular refractive surgery technique.
  • Percent tissue altered (PTA) is a factor in LASIK safety, with high PTA potentially increasing keratectasia risk.
  • The safety and efficacy of SMILE in eyes with high PTA values require further investigation.

Purpose of the Study:

  • To compare visual outcomes of ReLEx SMILE in eyes with low (<40%) and high (≥40%) PTA values up to 3 years post-surgery.
  • To evaluate the risk of keratectasia development in eyes with high PTA values after SMILE treatment.

Main Methods:

  • Retrospective analysis of 313 eyes with PTA <40% and 373 eyes with PTA ≥40%.
  • Evaluation of refraction, uncorrected (UDVA) and corrected distant visual acuity (CDVA), and wavefront data preoperatively and up to 3 years post-SMILE.
  • Comparison of visual outcomes and safety profiles between the low and high PTA groups.

Main Results:

  • Visual acuity outcomes were comparable between groups, with 97.7% (PTA <40%) and 96.4% (PTA ≥40%) maintaining or improving lines of vision.
  • UDVA of 20/20 or better was achieved in 74.4% (PTA <40%) and 71.8% (PTA ≥40%) of eyes.
  • No cases of keratectasia were observed in the high PTA group within the 3-year follow-up period.

Conclusions:

  • ReLEx SMILE demonstrates safety and efficacy for refractive correction, even in eyes with high PTA values (≥40%).
  • High PTA values in SMILE treatment did not correlate with an increased risk of keratectasia within the study's 3-year follow-up.
  • SMILE appears to be a safe alternative for patients with higher tissue alteration percentages.