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Comparison of biomechanical effects of small-incision lenticule extraction and laser in situ keratomileusis: finite-element analysis.

Abstract：

PURPOSE:To theoretically compare the corneal stress distribution of laser in situ keratomileusis (LASIK) with the stress distribution of small-incision lenticule extraction. SETTING:Cleveland Clinic Cole Institute, Cleveland, and The Ohio State University, Columbus, Ohio, USA. DESIGN:Computational modeling study. METHODS:A finite-element anisotropic collagen fiber-dependent model of myopic surgery using patient-specific corneal geometry was constructed for LASIK, small-incision lenticule extraction, and a geometry analog model with unaltered material properties from preoperative but with postoperative geometry including thickness. Surgical parameters, magnitude of myopic correction, LASIK flap thickness, and lenticule depth in small-incision lenticule extraction were varied. Two sets of models, 1 with uniform and 1 with depth-dependent material properties, were constructed. RESULTS:Stress distribution between small-incision lenticule extraction simulations and the geometry analog model were similar. In contrast, LASIK consistently reduced stress in the flap and increased stress in the residual stromal bed (RSB) compared with the geometry analog model. An increase in flap thickness or lenticule depth resulted in a greater increase in RSB stress in the LASIK model than in the small-incision lenticule extraction model. CONCLUSIONS:Small-incision lenticule extraction may present less biomechanical risk to the residual bed of susceptible corneas than comparable corrections involving LASIK flaps. Deeper corrections in the stroma may be possible in small-incision lenticule extraction without added risk for ectasia. FINANCIAL DISCLOSURES:Proprietary or commercial disclosures are listed after the references.

journal_name

J Cataract Refract Surg

journal_title

Journal of cataract and refractive surgery

authors

Sinha Roy A,Dupps WJ Jr,Roberts CJ

doi

10.1016/j.jcrs.2013.08.065

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

971-80

issue

eissn

0886-3350

issn

1873-4502

pii

S0886-3350(14)00400-3

journal_volume

pub_type

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Comparison of biomechanical effects of small-incision lenticule extraction and laser in situ keratomileusis: finite-element analysis.