Article Text

Influence of age on small incision lenticule extraction outcomes
  1. Laura Primavera1,
  2. Mario Canto-Cerdan1,
  3. Jorge L Alio1,2,
  4. Jorge L Alio del Barrio1,2
  1. 1 Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
  2. 2 Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
  1. Correspondence to Dr Jorge L Alio del Barrio, Cornea, cataract and External Disease, VISSUM Instituto Oftalmológico de Alicante, Alicante, Valenciana, Spain; jorge_alio{at}


Purpose To evaluate the influence of patient’s age at the time of surgery on small incision lenticule extraction (SMILE) refractive outcomes.

Methods This is a retrospective, consecutive, comparative study. We compared the refractive outcomes after myopic SMILE from two groups of patients divided by age (patients ≤35 and ≥40 years old). All eyes were evaluated preoperatively and at 1 and 6 months postoperatively. Main outcome measures were differences on efficacy, safety, predictability and astigmatic changes by vector analysis with ASSORT software between both study groups.

Results 102 matched eyes of 53 patients were included. Preoperatively, we evidenced no differences in the mean SE or astigmatism between groups. However, 6 months postoperatively we observed a significantly worse mean astigmatism (p=0.019), while not regarding SE, in the older population, with a trend towards undercorrection of the refractive cylinder in the ≥40 group. We also observed a statistically significant difference in the efficacy (0.86–1 month and 0.97–6 months in ≥40group vs 0.97–1 month and 1.07–6 months in the ≤35 group; p=0.003) and safety indexes (0.93–1 month and 1.04–6 months in ≥40 group vs 1.0–1 month and 1.11–6 months in the ≤35 group; p=0.008) at 6 months among groups.

Conclusions Post-SMILE refractive outcomes in those patients over 40 years of age, although acceptable, are not as good as those obtained in younger patients, showing a significantly lower efficacy and safety indexes, and poorer astigmatic outcomes, with a tendency towards undercorrection. We hypothetise that the increased corneal stroma stiffness in the aged group modifies the post-SMILE corneal stroma remodelling capacity, thus affecting the SMILE refractive and visual response.

  • treatment surgery
  • treatment lasers
  • cornea
  • vision
  • optics and refraction

Data availability statement

No data are available.

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  • Correction notice This article has been updated since it was published online. A funding statement has been added.

  • Funding This study has been supported by the Red Temática de Investigación Cooperativa en Salud (RETICS), reference number RD16/0008/0012, Funded by Instituto de Salud Carlos III and co-funded by European Regional Development Fund (ERDF), 'A way to make Europe'.

  • Competing interests JLAdB is part of the medical advisory board of CSO.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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