Quality control outcomes analysis of small-incision lenticule extraction for myopia by a novice surgeon at the first refractive surgery unit in Nepal during the first 2 years of operation

Abstract

Purpose: To evaluate the outcomes of small-incision lenticule extraction for myopia using the Visumax femtosecond laser at the first refractive surgery unit in Nepal during the first 30 months of operation.

Setting: Tilganga Institute of Ophthalmology, Kathmandu, Nepal.

Design: Retrospective noncomparative case series.

Methods: Consecutive myopic small-incision lenticule extraction procedures by a fellowship-trained surgeon were evaluated. Inclusion criteria were a preoperative spherical equivalent (SE) refraction up to -10.00 diopters (D) and corrected distance visual acuity (CDVA) of 20/20 or better. Outcomes analysis using the Standard Graphs for Reporting Refractive Surgery was performed over a 3-month follow-up.

Results: Three-month data were available for 1396 eyes. The mean attempted SE was -5.78 D ± 1.81 (SD) (range -0.96 to -10.00 D) and the mean cylinder, 0.79 ± 0.69 D (range 0.00 to 5.25 D). Postoperatively, the mean SE relative to target was -0.28 ± 0.29 D (range -1.31 to +1.50 D) and was within ± 0.50 D in 80% of eyes and ± 1.00 D in 99% of eyes. The uncorrected distance visual acuity was 20/20 or better in 95% of eyes and 20/25 or better in 99% of eyes. One line of CDVA was lost in 2% of eyes; no eye lost 2 or more lines. There was a small improvement in contrast sensitivity (P < .01).

Conclusions: The outcomes of myopic small-incision lenticule extraction up to -10.00 D performed at the first refractive surgery unit in Nepal by a fellowship-trained surgeon with no corneal refractive surgery experience were as safe and effective as outcomes in previous studies.

Financial disclosure: Dr. Reinstein is a consultant to Carl Zeiss Meditec AG and has a proprietary interest in the Artemis technology (Arcscan, Inc.) through patents administered by the Center for Technology Licensing at Cornell University, Ithaca, New York, USA. Drs. Pradhan and Carp have travel expenses to conferences paid by Carl Zeiss Meditec AG. No other author has a financial or proprietary interest in any material or method mentioned.