title: Vector analysis of low to moderate astigmatism with small incision lenticule extraction (SMILE): results of a 1-year follow-up.
abstract: BACKGROUND
  To evaluate the refractive outcomes for the correction of low to moderate astigmatism up to 1 year following small incision lenticule extraction (SMILE) surgery.
  
  
  METHODS
  This retrospective study enrolled 98 eyes from 98 patients who underwent SMILE surgery for the correction of myopia and astigmatism. Only right eyes were included in this study to avoid the bias of orientation errors. The vector method was used to analyze the outcomes of astigmatism at 1 month, 6 months and 12 months after the procedure, including the double-angle plots, correction index (CI), index of success (IOS), angle of error (AofE) and magnitude of error (MofE). The effectiveness, safety, stability and predictability were also investigated during the 12-month follow-up.
  
  
  RESULTS
  The preoperative cylinder ranged from -2.75 D to -0.25 D (average of -0.90±0.68 D), and the mean postoperative cylinder values were -0.24±0.29 D, -0.24±0.29 D, and -0.20±0.27 D at 1 month, 6 months, and 12 months, respectively. The mean astigmatism in vector form was -0.14 D×27.19° at 1 month, -0.13 D×27.29° at 6 months, and -0.10 D×28.63° at 12 months after surgery. The CI was 1.00±0.32 and IOS was 0.29±0.44 at the 12-month follow-up. Significant negative correlations were found between the CI and absolute target induced astigmatism (TIA) value, and positive correlations were found between the IOS and absolute AofE value (P<0.05). The MofE was limited within ±1.00 D at the 12-month follow-up. Fifty-six eyes (57.1%) gained one line in corrected distance visual acuity (CDVA) and five eyes (5.1%) gained two lines. There were no significant differences observed in the refractive outcomes among time points.
  
  
  CONCLUSIONS
  SMILE surgery was effective and safe in correcting low to moderate astigmatism, and stable refractive outcomes were observed at the long-term follow-up. The undercorrection of astigmatism could possibly be influenced by attempted astigmatism correction preoperatively, the axis rotation during the surgery or wound healing postoperatively. This study suggested that nomograms should be adjusted in correcting astigmatism with SMILE surgery.
authors.affiliation: Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No.4 Gansu Rd, Heping District, Tianjin, 300020, China.
authors.forename: Jiamei
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No.4 Gansu Rd, Heping District, Tianjin, 300020, China. wangyan7143@vip.sina.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No.4 Gansu Rd, Heping District, Tianjin, 300020, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Wu
authors.affiliation: Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No.4 Gansu Rd, Heping District, Tianjin, 300020, China.
authors.forename: Lulu
authors.initials: L
authors.lastname: Xu
authors.affiliation: Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No.4 Gansu Rd, Heping District, Tianjin, 300020, China.
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Li
authors.affiliation: Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No.4 Gansu Rd, Heping District, Tianjin, 300020, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Dou
mesh_terms: D000293:Adolescent; D000328:Adult; D001251:Astigmatism / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods; D008297:Male; D009216:Myopia / Q000601:surgery*; D054140:Refractive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult