Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0180941
Title: Retreatment strategies following Small Incision Lenticule Extraction (SMILE): In vivo tissue responses
Authors: Riau A.K.
Liu Y.-C. 
Lim C.H.L.
Lwin N.C.
Teo E.P.
Yam G.H. 
Tan D.T. 
Mehta J.S. 
Keywords: CD11b antigen
fibronectin
fibronectin
Ki 67 antigen
animal cell
animal experiment
animal tissue
anterior segment optical coherence tomography
apoptosis
Article
cell death
confocal microscopy
controlled study
cornea disease
cornea edema
corneal haze
immunohistochemistry
in vivo study
inflammation
intermethod comparison
New Zealand White (rabbit)
nonhuman
ophthalmic excimer laser
ophthalmic femtosecond laser
ophthalmic laser
optical coherence tomography
Oryctolagus cuniculus
postoperative complication
retreatment
small incision lenticule extraction
surface ablation
tissue reaction
TUNEL assay
wound healing
animal
cornea
cornea stroma
diagnostic imaging
excimer laser
Leporidae
metabolism
pathology
photorefractive keratectomy
surgery
Animals
Antigens, CD11b
Apoptosis
Cornea
Corneal Stroma
Fibronectins
Ki-67 Antigen
Lasers, Excimer
Microscopy, Confocal
Photorefractive Keratectomy
Rabbits
Tomography, Optical Coherence
Issue Date: 2017
Citation: Riau A.K., Liu Y.-C., Lim C.H.L., Lwin N.C., Teo E.P., Yam G.H., Tan D.T., Mehta J.S. (2017). Retreatment strategies following Small Incision Lenticule Extraction (SMILE): In vivo tissue responses. PLoS ONE 12 (7) : e0180941. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0180941
Rights: Attribution 4.0 International
Abstract: With any refractive correction, including Small Incision Lenticule Extraction (SMILE), there may be a residual refractive error that requires a retreatment. Here, we investigated the tissue responses following various retreatment procedures in a rabbit model of SMILE. All rabbits underwent a -6.00D correction with SMILE. Two weeks later, they underwent -1.00D enhancement by: (i) VisuMax Circle, followed by excimer ablation (S+C); (ii) secondary SMILE anterior to the primary procedure (S+SE); or (iii) surface ablation (S+P), and were examined for 28 days. S+P induced corneal edema and haze, and more CD11b- (23±6 cells) and TUNEL-positive (36±4 cells) cells in the central stromal superficial layers early post-operatively (p<0.001 compared to other procedures). The corneas appeared normal on day 28 after S+P, but had a lower number of keratocytes near the laser ablated plane compared to other procedures. S+SE and S+C did not induce corneal haze and resulted similar level of fibronectin. However, S+C resulted in more inflammatory (10±2 cells; p = 0.001) and apoptotic cells (25±2 cells; p<0.001) compared to S+SE (7±1 inflammatory cells and 21±3 apoptotic cells) early post-operatively. In conclusion, each SMILE retreatment method resulted in unique tissue responses. S+SE offers advantages, such as minimal inflammation and cell death, as well as maintaining a ‘flap-less’ surgery, over other procedures. However, depending on the degree of enhancement, the lenticule may become too thin to be extracted and the procedure becomes more difficult to perform than S+C and S +P. S+P can maintain corneal integrity by avoiding flap creation and is technically more simple to perform than the others, but the surgery needs to be supplemented with mitomycin-C in order to reduce inflammation and modulate better wound healing. © 2017 Riau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161184
ISSN: 19326203
DOI: 10.1371/journal.pone.0180941
Rights: Attribution 4.0 International
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