title: Intra-Operative Cap Repositioning in Small Incision Lenticule Extraction (SMILE) for Enhanced Visual Recovery.
abstract: To study the role of intra-operative cap repositioning in acute visual recovery after small incision lenticule extraction (SMILE).
  
  
  
  Ninety-four eyes of 47 patients underwent the SMILE procedure for correction of myopic refractive error. Manifest refraction and visual quality parameters (optical quality analysis system) were evaluated before surgery. The Bowman's membrane was imaged using a handheld spectral domain optical coherence tomography device. All patients underwent an uneventful SMILE surgery by a single experienced surgeon. Intra-operative cap repositioning was done in the "right" eye of all patients (repositioned group) and the "left" eye of each patient served as controls (non-repositioned group). Visual acuity and optical quality were assessed 1 day and 1 week after surgery.
  
  
  
  Bowman's membrane microdistortions were found in 21.3% of eyes in the repositioned group and 59.57% of the eyes in the non-repositioned group (p = 0.003) on the first day after surgery. Comparison of optical quality parameters was carried out between eyes where repositioning was done and control eyes (with and without microdistortions). On the first day after surgery, the modulation transfer function (MTF) and Strehl's ratio (SR) were significantly better in the repositioned group when compared with the controls (p = 0.002 and p = 0.003, respectively). Refractive error and lenticule thickness in eyes with microdistortions were similar (p > 0.05) between the two groups indicating other contributors to acute optical quality postoperatively.
  
  
  
  Although the refractive error before surgery determines the extent of microdistortions, intra-operative cap repositioning can reduce them, thereby expediting acute visual recovery after SMILE.
authors.affiliation: a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.|b Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Shetty
authors.affiliation: a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.
authors.forename: Rushad
authors.initials: R
authors.lastname: Shroff
authors.affiliation: a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.
authors.forename: Luci
authors.initials: L
authors.lastname: Kaweri
authors.affiliation: a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.
authors.forename: Chaitra
authors.initials: C
authors.lastname: Jayadev
authors.affiliation: a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.
authors.forename: Mathew Kurian
authors.initials: MK
authors.lastname: Kummelil
authors.affiliation: c Imaging, Biomechanics and Mathematical Modeling Solutions , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Sinha Roy
mesh_terms: D000293:Adolescent; D000328:Adult; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D012029:Refraction, Ocular; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
keywords: Handheld spectral domain optical coherence tomography; microdistortions; repositioning; small incision lenticule extraction (SMILE); visual quality