title: 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: OBJECTIVE
  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.
  
  
  METHODS
  Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  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.
authors.affiliation: From the Tilganga Institute of Ophthalmology (Pradhan, Dhungana), Kathmandu, Nepal; London Vision Clinic (Reinstein, Carp, Archer, Gobbe), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France.
authors.forename: Kishore R
authors.initials: KR
authors.lastname: Pradhan
authors.affiliation: From the Tilganga Institute of Ophthalmology (Pradhan, Dhungana), Kathmandu, Nepal; London Vision Clinic (Reinstein, Carp, Archer, Gobbe), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France. Electronic address: dzr@londonvisionclinic.com.
authors.forename: Dan Z
authors.initials: DZ
authors.lastname: Reinstein
authors.affiliation: From the Tilganga Institute of Ophthalmology (Pradhan, Dhungana), Kathmandu, Nepal; London Vision Clinic (Reinstein, Carp, Archer, Gobbe), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France.
authors.forename: Glenn I
authors.initials: GI
authors.lastname: Carp
authors.affiliation: From the Tilganga Institute of Ophthalmology (Pradhan, Dhungana), Kathmandu, Nepal; London Vision Clinic (Reinstein, Carp, Archer, Gobbe), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Archer
authors.affiliation: From the Tilganga Institute of Ophthalmology (Pradhan, Dhungana), Kathmandu, Nepal; London Vision Clinic (Reinstein, Carp, Archer, Gobbe), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Gobbe
authors.affiliation: From the Tilganga Institute of Ophthalmology (Pradhan, Dhungana), Kathmandu, Nepal; London Vision Clinic (Reinstein, Carp, Archer, Gobbe), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France.
authors.forename: Purushottam
authors.initials: P
authors.lastname: Dhungana
mesh_terms: D000047:Academies and Institutes; D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D059032:Learning Curve; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D009390:Nepal; D049451:Nomograms; D009885:Ophthalmology / Q000193:education; D011786:Quality Control; D012029:Refraction, Ocular / Q000502:physiology; D054140:Refractive Surgical Procedures / Q000193:education*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult