Incidence and Management of Epithelial-Related Complications After SMILE

Majid Moshirfar; Stephanie Zhang; Shreya Pandya; Isabella M Stoakes; Phillip C Hoopes

doi:10.2147/OPTH.S426547

Incidence and Management of Epithelial-Related Complications After SMILE

Clin Ophthalmol. 2023 Sep 20:17:2777-2789. doi: 10.2147/OPTH.S426547. eCollection 2023.

Authors

Majid Moshirfar^{1

2

3}, Stephanie Zhang⁴, Shreya Pandya⁵, Isabella M Stoakes^{1

6}, Phillip C Hoopes¹

Affiliations

¹ Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.
² John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
³ Utah Lions Eye Bank, Murray, UT, USA.
⁴ University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
⁵ University of Louisville School of Medicine, Louisville, KY, USA.
⁶ Pacific Northwest University of Health Sciences, Yakima, WA, USA.

Abstract

Purpose: To investigate the incidence and management of only epithelial-related complications following small incision lenticule extraction (SMILE).

Patients and methods: A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups.

Results: Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye). There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001). Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001). However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively). There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively).

Conclusion: In our study, epithelial-related complications were more prevalent in older patients and predisposed patients to require PRK enhancements after recovery from SMILE. Despite the incidence of epithelial-related complications, visual prognoses were favorable and achieved through various management strategies.

Keywords: DLK; LASIK; ReLEx; diffuse lamellar keratitis; epithelial ingrowth; microstriae.