title: In Vivo and Ex Vivo Evaluation of Inflammation and Apoptosis Induced after SMILE Procedures for Different Refractive Error Range.
abstract: To detect corneal inflammation and apoptosis induced after small incision lenticule extraction (SMILE) at different refractive corrections for moderate to high values of myopia.
  
  
  
  Fifty patients (50 eyes) suffering from medium to high myopia (spherical equivalent refraction from -3.75 to -10.00 diopters (D) with refractive astigmatism under -0.75 D) underwent SMILE in order to correct myopic error. In vivo evaluation was done by corneal confocal microscopy (IVCM) and ex vivo by immunohistochemistry. After surgery, all corneal lenticules were checked for regularity, entirety, and fixed in formalin for immunohistochemistry evaluation of apoptosis (TUNEL) and inflammation (CD11b) levels. Postoperative assessments took place during the first week and the first and third months after surgery. Patients returned for IVCM examination for analysis of the corneal stromal femtosecond laser treatment interfaces reflectivity.
  
  
  
  No correlation was observed between treated myopic refractive error and number of CD11b+and TUNEL+cell in all analyzed extracted lenticules. IVCM at 1 week and 1 month of follow-up showed numerous reflective particles at the laser treatment interface with a moderate light scattering. In semi-quantitative analysis of reflectivity intensity at the laser interfaces, a statistical difference was evident only between 1 week and 1 month (p = 0.0213).
  
  
  
  SMILE, as an innovative all-femto surgical procedure, results in a reduced tissue inflammation and apoptosis levels with a minimum tissue response, in terms of interface reflectivity, and there are no statistically significant differences among variable treated refractive error range.
authors.affiliation: a Department of Medicine and Ageing Sciences, Ophthalmology Clinic , University "G. d' Annunzio" of Chieti-Pescara , Chieti , Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
authors.affiliation: a Department of Medicine and Ageing Sciences, Ophthalmology Clinic , University "G. d' Annunzio" of Chieti-Pescara , Chieti , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Calienno
authors.affiliation: b Department of Medicine and Ageing Sciences, Visual Science Laboratory , CeSI, University "G. d' Annunzio" of Chieti and Pescara , Chieti , Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Curcio
authors.affiliation: c Ophthalmology Clinic , University of Verona , Verona , Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.affiliation: a Department of Medicine and Ageing Sciences, Ophthalmology Clinic , University "G. d' Annunzio" of Chieti-Pescara , Chieti , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Nubile
authors.affiliation: a Department of Medicine and Ageing Sciences, Ophthalmology Clinic , University "G. d' Annunzio" of Chieti-Pescara , Chieti , Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Salgari
authors.affiliation: a Department of Medicine and Ageing Sciences, Ophthalmology Clinic , University "G. d' Annunzio" of Chieti-Pescara , Chieti , Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Lanzini
mesh_terms: D000328:Adult; D017209:Apoptosis; D001251:Astigmatism / Q000473:pathology* / Q000601:surgery; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D007249:Inflammation / Q000473:pathology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D014792:Visual Acuity; D055815:Young Adult
keywords: Apoptosis; SMILE; immunohistochemistry; inflammation; refractive error