Small-incision lenticule extraction for the correction of myopic astigmatism

Purpose: To report the outcomes of small-incision lenticule extraction (SMILE) in myopic eyes with astigmatism of 1.0 to 3.0 diopters (D). Setting: Center for Refractive Surgery, Eye Department, St. Francis Hospital, Muenster, Germany. Design: Retrospective case series. Methods: Inclusion criteria were myopia of -0.5 D or more, astigmatism between -1.0 D and 3.0 D, and decimal corrected distance visual acuity (CDVA) of 1.0 or better. Results: The study comprised 206 eyes. Preoperatively, the mean attempted spherical equivalent (SE) correction was -5.45 +/- 2.37 D (range -1.25 to -11.38 D) and the mean cylinder was -1.52 +/- 0.57 D (range -1.0 to -3.0 D). Three months postoperatively, the mean SE refraction was -0.07 +/- 0.38 D (range -1.25 to +1.00 D) and the mean cylinder was -0.32 +/- 0.29 D (range 0.0 to -1.5 D). The mean decimal uncorrected distance visual acuity (UDVA) was 1.13, the mean efficacy index was 0.87, and the mean safety index was 1.00. The UDVA was the same as or better than the CDVA in 67% of cases. The angle of error was +/- 5 degrees in 67% and +/- 15 degrees in 94% of cases, and the residual astigmatism was 0.5 D or less in 88% and 1.0 D or less in all patients. Conclusion: Small-incision lenticule extraction for the correction of myopic astigmatism was safe and effective, with outcomes comparable to those reported for laser in situ keratomileusis using modern eye-tracking systems. (C) 2018 ASCRS and ESCRS