Bilateral Lenticule Creation Followed by Bilateral Lenticule Separation Improves Visual Outcomes After SMILE

Area of Science:

• Ophthalmology and Optometry
• Refractive Surgery
• Corneal Surgery

Background:

• Small Incision Lenticule Extraction (SMILE) is a popular refractive surgical procedure.
• The sequence of surgical steps in bilateral SMILE may influence postoperative outcomes.
• Propensity score matching (PSM) is a valuable statistical method for analyzing observational studies with confounding factors.

Purpose of the Study:

• To investigate the impact of different surgical sequences on visual and refractive outcomes in bilateral SMILE.
• To compare visual results between two distinct surgical sequences using PSM analysis.

Main Methods:

• Retrospective analysis of 1,854 eyes from 927 participants undergoing uneventful SMILE.
• Two surgical sequences were compared: Sequence A (sequential eye surgery) and Sequence B (bilateral laser scanning followed by bilateral lenticule separation).
• PSM was employed to match patients and minimize confounding factors, with outcomes assessed at multiple postoperative time points.

Main Results:

• After PSM, 534 eyes (267 patients) were matched 1:1 between Sequence A and Sequence B.
• Significant differences in corrected distance visual acuity at 3 months and uncorrected distance visual acuity at all follow-ups were observed between the groups.
• Sequence B demonstrated superior safety and efficacy indices at 3 months compared to Sequence A; no inter-eye differences were noted.

Conclusions:

• Performing bilateral lenticule creation followed by bilateral lenticule separation (Sequence B) resulted in better postoperative visual outcomes than sequential eye surgery (Sequence A).
• The surgical sequence in SMILE does not impact outcomes between the right and left eyes.
• Optimizing the surgical sequence may be a viable strategy to enhance visual results after bilateral SMILE.