title: Visual Outcomes After SMILE, LASEK, and LASEK Combined With Corneal Collagen Cross-Linking for High Myopic Correction.
abstract: OBJECTIVE
  To compare the visual and refractive outcomes of small-incision lenticule extraction (SMILE), laser-assisted subepithelial keratomileusis (LASEK), and LASEK combined with corneal collagen cross-linking (LASEK-CXL) surgery for high-degree myopia.
  
  
  METHODS
  Medical records of patients with spherical equivalent (SE) greater than -6.00 diopters (D) treated with SMILE, LASEK, and LASEK-CXL were reviewed. Uncorrected distance visual acuity (UCVA), SE, and corneal haze were followed up in the 3 groups for 6 months.
  
  
  RESULTS
  The SMILE group included 69 eyes, the LASEK group included 61 eyes, and the LASEK-CXL group included 40 eyes. At 6 months postoperatively, there were no statistically significant differences in UCVA between the SMILE, LASEK, and LASEK-CXL groups (logMAR 0.00 ± 0.00, 0.01 ± 0.08, and 0.01 ± 0.08, respectively, P = 0.69). The averages of the absolute value of SE were 0.34 ± 0.25 D, 0.50 ± 0.36 D, and 0.42 ± 0.34 D in the SMILE, LASEK, and LASEK-CXL groups, respectively (P = 0.04). The percentages of the patients with a postoperative residual refractive error within ±0.50 D were 84% in the SMILE group, 65% in the LASEK group, and 76% in the LASEK-CXL group. The percentages of the patients with greater than 20/25 postoperative UCVA were 100%, 91%, and 95%, respectively. SMILE produced no postoperative corneal haze. However, 18% of patients treated with LASEK and 25% of those treated with LASEK-CXL had corneal haze at 6 months postoperatively.
  
  
  CONCLUSIONS
  SMILE, LASEK, and LASEK-CXL surgery appear to be safe and effective for high-degree myopic correction. However, the SMILE group had no haze and fewer induction of some higher-order aberrations compared with the LASEK and LASEK-CXL groups.
authors.affiliation: *Department of Ophthalmology, Chungbuk National University, Cheongju, Chunbguk, Korea; and †Nuri Eye Ophthalmic Clinic, Daejeon, Korea.
authors.forename: Sangyoon
authors.initials: S
authors.lastname: Hyun
authors.forename: Seongjun
authors.initials: S
authors.lastname: Lee
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism; D048988:Corneal Surgery, Laser / Q000009:adverse effects / Q000379:methods; D003432:Cross-Linking Reagents; D005260:Female; D006801:Humans; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000009:adverse effects / Q000379:methods*; D008297:Male; D047728:Myopia, Degenerative / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin