7-Year Results of SMILE for High Myopia: Visual and Refractive Outcomes and Aberrations
Iben Bach Damgaard, Henrik Sejersen, Anders Ivarsen, Jesper Hjortdal
Abstract
PURPOSE: To evaluate the 7-year visual, refractive, and optical outcomes following small incision lenticule extraction (SMILE) for high myopia and myopic astigmatism. METHODS: Sixty-nine eyes (69 patients) undergoing SMILE between March 2011 and January 2012 at Aarhus University Hospital were included. Preoperative, 3-month, 3-year, and 7-year evaluation included: manifest refraction and uncorrected (UDVA) and corrected (CDVA) distance visual acuities, total corneal refractive power (TCRP), average keratometry (Km), aberrations, and central corneal thickness (CCT). RESULTS: Preoperative spherical equivalent averaged −7.53 ± 1.18 diopters (D). Twenty-seven eyes were targeted emmetropia. In the emmetropic eyes, the postoperative logMAR UDVA remained stable ( P = .11). When including all eyes, UDVA became worse from 3 to 7 years (3 months: 0.050 ± 0.16 logMAR; 3 years: 0.044 ± 0.21 logMAR; 7 years: 0.131 ± 0.29 logMAR; P < .027), whereas CDVA remained stable (3 months: −0.07 ± 0.09 logMAR; 3 years: −0.09 ± 0.08 logMAR; 7 years: −0.09 ± 0.08 logMAR, P > .99). At 7 years, 59.4% and 81.2% were within ±0.50 and ±1.00 D of target refraction, respectively. Average refractive regression was significant from 3 months to 7 years (−0.34 ± 0.69 D) and from 3 to 7 years (−0.25 ± 0.41 D, P < .05). After exclusion of three outliers with high myopic correction (< 9.63 D) and considerable regression (<−1.50 D), the average regression over 7 years was −0.25 ± 0.49 D ( P = .004) with no significant change from 3 to 7 years ( P = .069). Average CCT, TCRP, and anterior Km significantly increased ( P < .001), whereas the posterior Km and total corneal aberrations remained stable ( P > .092). CONCLUSIONS: The long-term visual outcome remained stable after SMILE, but with an average regression of −0.34 D over 7 years. A minor group with high myopic correction exhibited considerable refractive regression years after SMILE. [ J Refract Surg . 2021;37(10):654–661.]