Preoperative Axial Length and Macular Thickness as Predictors of Myopic Regression Following Refractive Surgery

Incidence of posterior vitreous detachment after three different types of laser refractive surgery.

PURPOSE To compare the incidence of posterior vitreous detachment (PVD) after small incision lenticule extraction (SMILE), femtosecond laser in situ keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy(T-PRK), and to evaluate its potential risk factors and association with early postoperative visual and refractive outcomes. METHODS Patients who met the eligibility criteria for SMILE, FS-LASIK, or T-PRK after comprehensive preoperative evaluation were enrolled. B-scan ultrasonography was performed by a single operator one day before surgery, and patients with preoperative PVD were excluded. Finally, 24 patients (45 eyes) were included in the SMILE group (Group S), 21 patients (39 eyes) in the FS-LASIK group (Group F), and 22 patients (44 eyes) in the T-PRK group (Group T). All procedures were performed by the same surgeon. B-scan ultrasonography was repeated by the same operator 1 week after surgery to detect newly developed PVD. RESULTS The mean age was 21.5 ± 5.56 years, 23.9 ± 5.00 years, and 22.9 ± 4.56 years in Groups S, F, and T, respectively (p = 0.484). The mean axial length was 25.80 ± 0.87 mm, 25.91 ± 0.80 mm, and 25.72 ± 0.94 mm, respectively (p = 0.603), and the mean spherical equivalent was -4.65 ± 1.49 D, -5.33 ± 1.79 D, and -4.70 ± 1.36 D, respectively (p = 0.080). Postoperative PVD was detected in 9 eyes in Group S (20.0%; 95% CI, 9.6%-34.6%), 7 eyes in Group F (17.9%; 95% CI, 7.5%-33.5%), and 5 eyes in Group T (11.4%; 95% CI, 3.8%-24.6%) (p = 0.570). CONCLUSIONS No statistically significant difference in early postoperative PVD incidence was observed among SMILE, FS-LASIK, and T-PRK within one week after surgery. Further studies with larger sample sizes and longer follow-up are needed to confirm these findings.

Potential risk of capsular tension ring implantation combined with phacoemulsification in high myopia patients by increasing central macular thickness and intraocular lens tilt: a retrospective comparative study with 1-week, 1-month, and 3-month outcomes

This study investigated the effects of phacoemulsification combined with capsular tension ring (CTR) implantation on the central macular thickness (CMT) and intraocular lens (IOL) tilt in highly myopic eyes with cataract at 3 months postoperatively. A retrospective study analyzed 169 highly myopic eyes from 91 cataract patients, divided into two groups: the CTR group (47 patients, 86 eyes) underwent phacoemulsification with CTR implantation, and the control group (44 patients, 83 eyes) underwent phacoemulsification alone. Patients were further stratified by axial length (AL) into two subgroups: 26 mm ≤ AL <30 mm and AL ≥ 30 mm. Postoperative outcomes, including refractive prediction error (RPE), CMT changes, IOL tilt, and decentration, were assessed at 1 week, 1 month, and 3 months. Visual acuity was quantified using logarithm of the minimum angle of resolution (LogMAR). In accordance with the principle that a higher LogMAR value indicates poorer vision, best-corrected visual acuity (BCVA) improved significantly in both groups compared with preoperative levels at 1 week (0.14 ± 0.23 vs. 0.29 ± 0.44), 1 month (0.14 ± 0.30 vs. 0.25 ± 0.38), and 3 months (0.11 ± 0.21 vs. 0.24 ± 0.39) postoperatively (p < 0.05). Notably, BCVA in the subgroup with AL of 26 mm ≤ AL <30 mm was significantly better than that in the subgroup with AL ≥ 30 mm (p < 0.05). Additionally, no significant difference in RPE was observed between the two groups at any of the three time points (all p > 0.05). However, although IOL position (tilt and decentration) did not differ significantly between groups at 1 or 3 months overall, the CTR subgroup with 26 mm ≤ AL <30 mm exhibited greater IOL tilt (5.275 ± 3.708°) than the control subgroup (3.846 ± 2.262°) at 3 months (p = 0.021). Similarly, while no overall intergroup difference in CMT was detected across time points, the CTR subgroup with 26 mm ≤ AL <30 mm showed a significantly greater mean CMT change (8.831 ± 27.656 μm) compared with the control subgroup (−4.270 ± 32.486 μm) at 1 week (p = 0.046). CTR implantation during phacoemulsification poses a potential risk in high myopia patients, particularly those with axial lengths between 26 mm and 30 mm, by increasing both CMT and IOL tilt.

Enhanced predictability and axis precision of SMILE Pro, a retrospective analysis of myopic astigmatism correction.

AIM To evaluate three-month visual and refractive outcomes after small incision lenticule extraction (SMILE) Pro with the VISUMAX 800 femtosecond laser for myopic astigmatism correction and to compare results with previously reported VISUMAX 800 and VisuMax 500 outcomes. METHODS Retrospective, observational clinical study. Records of 64 patients (128 eyes) who underwent SMILE Pro using the VISUMAX 800 laser (Carl Zeiss Meditec AG, Jena, Germany) between June and November 2024 were reviewed. Preoperative and 3-month postoperative data were analyzed in eyes with corrected distance visual acuity (CDVA) of 1.0 or better, including spherical equivalent (SE), refractive astigmatism, and vector analysis. Patients were classified into low (≤1.50 D) and high (>1.50 D) astigmatism subgroups. RESULTS The mean age of 64 patients (128 eyes) was 26.10±4.25y (19-36y). Attempted and achieved SE were strongly correlated (r=0.97, P<0.001). At 3mo, 36.7% and 87.5% of eyes were within ±0.50 and ±1.00 D of target refraction, respectively. Mean residual astigmatism was -0.56±0.27 D, lower in the low-astigmatism group (-0.39±0.23 D) than in the high group (-0.72±0.21 D; P<0.001). The mean absolute astigmatic angle of error was 4.47°±4.68°, with 97.6% ≤15°. No intraoperative or postoperative complications occurred. CONCLUSION SMILE Pro using the VISUMAX 800 femtosecond laser provides safe and predictable correction of myopic astigmatism with good axis alignment. However, the observed undercorrection in higher cylinders suggests that further optimization of astigmatic nomograms may improve refractive accuracy.

Prospective evaluation of axial length and refractive stability after small-incision lenticule extraction in young adults with progressive myopia.

This study aimed to evaluate the effect of small-incision lenticule extraction (SMILE/KLEx) on axial length (AXL) progression and refractive stability in young adults with moderate to high myopia and documented preoperative progression. This prospective study included 100 eyes of 50 patients aged 18-21 years who underwent SMILE/KLEx. AXL, spherical equivalent (SE), corneal curvature, and central corneal thickness (CCT) were measured 1 year pre-baseline (T - 1), at baseline (T0), and postoperatively at 6 months (T1), 1 year (T2), and 3 years (T3). Agreement between estimated and observed AXL elongation was assessed using Bland-Altman analysis, and generalized estimating equation (GEE) models were used to account for inter-eye correlations and evaluate changes from baseline. Median AXL showed limited progression throughout follow-up (26.05 mm at T0, 26.14 mm at T2, 26.26 mm at T3), SE improved from - 6.00 D to - 0.25 D, and corneal parameters showed early postoperative changes followed by long-term stability. Visual outcomes were satisfactory, with no significant intraoperative or postoperative complications. In conclusion, SMILE/KLEx provided effective refractive correction in this cohort of young adults with documented preoperative myopic progression. Over 3 years, axial length showed no statistically significant progression at the group level, although individual-level elongation was heterogeneous and remained within the expected physiological range for young adults.

Functional and structural outcomes after vitrectomy: The role of macular contour restoration

Postoperative restoration of the foveal pit is strongly associated with superior BCVA gain and CMT reduction, highlighting foveal morphology as a key prognostic marker for surgical success.

Predictive factors associated with the safety and efficacy of refractive surgery for Myopia: a retrospective cohort study.