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Four-year outcomes of small incision lenticule extraction (SMILE) to correct high myopic astigmatism
  1. Yuanyuan Zhong1,2,
  2. Meng Li3,4,5,6,
  3. Tian Han3,4,5,6,
  4. Dan Fu3,4,5,6,
  5. Xingtao Zhou3,4,5,6
  1. 1 The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  2. 2 Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
  3. 3 Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
  4. 4 Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
  5. 5 NHC Key Laboratory of Myopia, Shanghai, China
  6. 6 Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
  1. Correspondence to Dr Xingtao Zhou, Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200433, China; doctzhouxingtao{at}


Aims To evaluate the long-term outcomes of small incision lenticule extraction (SMILE) in subjects with myopic astigmatism of ≥2.00 dioptres (D).

Methods Patients who underwent SMILE 4 years prior with astigmatism ≥2.00 D and ≤1.00 D were assigned to the high astigmatic group (HA group) or the low astigmatic group (LA group), respectively. The visual and refractive results as well as corneal wavefront aberrations were measured.

Results The preoperative cylinder was −2.47±0.54 D in 43 eyes in the HA group and −0.55±0.28 D in 31 eyes in the LA group. At 4 years, the residual cylinder was −0.31±0.29 D in the HA group and −0.20±0.28 D in the LA group (p=0.088). An uncorrected distance visual acuity of 20/20 was achieved in 88.4% of eyes in the HA group and 93.5% of eyes in the LA group. The efficacy index was 0.99±0.14 and 1.10±0.21 (p=0.025), and the safety index was 1.11±0.20 and 1.22±0.21 in the HA and LA groups, respectively (p=0.012). Eighty-six per cent and 90.3% of eyes were within ±0.50 D of the attempted cylindrical correction in the HA and LA groups, respectively. Vector analysis showed that the magnitude of error was −0.14±0.28 D and −0.05±0.16 D (p=0.085), the angle of error was −0.13±4.48 degrees and −2.57±29.42 degrees (p=0.592), the correction index was 0.94±0.13 and 0.94±0.35 (p=0.959), the index of success was 0.15±0.14 and 0.46±0.62 (p=0.517), and the flattening index was 0.93±0.13 and 0.71±0.59 (p=0.450) in the HA and LA groups, respectively.

Conclusions This study demonstrates that SMILE is effective and safe for correcting high astigmatism. Vector analysis shows a tendency for the undercorrection of astigmatism in subjects with high astigmatism.

  • optics and refraction

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  • YZ and ML are joint first authors.

  • Contributors XZ, YZ and ML: study concept and design. YZ, ML, TH and DF: data collection and analysis. YZ and ML: writing the manuscript. YZ, ML, TH, DF and XZ: critical revision of the manuscript. All authors gave final approval of the article.

  • Funding National Natural Science Foundation of China (Grant No. 81570879) & (Grant No. 81770955); Project of Shanghai Science and Technology (Grant No. 17411950200); Joint research project of new frontier technology in municipal hospitals (SHDC12018103).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. If the original data about the research is required, please contact the corresponding author by e-mail.

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