Influence of Preoperative Astigmatism Type and Magnitude on the Effectiveness of SMILE Correction.

PURPOSE: To assess the effectiveness of small incision lenticule extraction (SMILE) as a function of the astigmatism level and type.

METHODS

A total of 102 right eyes were included in this study. Refractive astigmatism and corneal astigmatism measured with Scheimpflug technology were retrieved from the preoperative visit and the 3-month follow-up visit. Patients were split into three groups according to the preoperative refractive astigmatism (0.50, 0.75 to 1.25, and 1.50 diopters [D] or greater) and the effectiveness among each group was evaluated according to the with-the-rule (WTR), against-the-rule (ATR), and oblique classifications. The standard Alpins method was used for the analysis.

RESULTS

Resultant astigmatism was not associated with its preoperative classification when the total sample was considered, but a significant association emerged between the presence of resultant astigmatism and its preoperative classification in the 1.50 D or greater group. The magnitude of error was significantly lower in the WTR (median: -0.30 D) than in the oblique and ATR astigmatism groups, resulting in a coefficient of adjustment of 1.13 for WTR astigmatism of 1.50 D or greater but not for the other types.

CONCLUSIONS

Astigmatism correction with SMILE is predictable for astigmatism lower than 1.50 D without the need to apply a correction. However, higher undercorrection is present in WTR astigmatism of 1.50 D or greater. [J Refract Surg. 2019;35(1):40-47.].