A microscopic study of the corneal stromal lenticules extracted during femtosecond laser‑assisted small incision lenticule extraction

Yin,Yewei; Hu,Tu; Xiang,Aiqun; Fu,Yanyan; Zhao,Yang; Wu,Xiaoying; Wu,Xiaoying; Wen,Dan

doi:10.3892/etm.2021.10113

A microscopic study of the corneal stromal lenticules extracted during femtosecond laser‑assisted small incision lenticule extraction

Authors:
- Yewei Yin
- Tu Hu
- Aiqun Xiang
- Yanyan Fu
- Yang Zhao
- Xiaoying Wu
- Xiaoying Wu
- Dan Wen
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Affiliations: Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China, Department of Pathology, College of Basic Medicine, Central South University, Changsha, Hunan 410008, P.R. China
Published online on: April 25, 2021 https://doi.org/10.3892/etm.2021.10113
Article Number: 681

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Abstract

The aim of the present study was to investigate the histological and morphological characteristics of corneal stromal lenticules extracted during femtosecond laser‑assisted small incision lenticule extraction (SMILE) surgery by light and electron microscopy. A total of 20 human corneal stromal lenticules extracted during SMILE surgery were sent for microscopic examination immediately after surgery. Of these, six were observed under a light microscope and 14 were observed under an electron microscope. The smoothness of the front and rear surface of the lenticules observed under an electron microscope was rated on a scale of 0 to 4 according to unified evaluation criteria and the scores were statistically compared. Under the light microscope, the edge of the cross section of the corneal stromal lenticules was deeply stained and certain burrs and broken collagen fibers were observed. The swollen corneal stromal fibers were distributed irregularly, with a few bubbles of different sizes. Under the electron microscope, the surface of the lenticules ablated using a femtosecond laser was not perfectly smooth and the front surface was smoother than the rear surface. The side edge of the lenticules ablated using a femtosecond laser was not as regular as the edge cut using microscissors. Necrosis and dissolution of collagen fibers were observed near the surface of the lenticules. In conclusion, the surface quality of corneal stromal lenticules ablated using a femtosecond laser was not optimal when observed under a microscope. Increased attention should be paid to the histology and morphology of the corneal surface following laser ablation.

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1	Aristeidou A, Taniguchi EV, Tsatsos M, Muller R, McAlinden C, Pineda R and Paschalis EI: The evolution of corneal and refractive surgery with the femtosecond laser. Eye Vis (Lond). 2(12)2015.PubMed/NCBI View Article : Google Scholar
2	Reinstein DZ, Archer TJ and Gobbe M: Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye Vis (Lond). 1(3)2014.PubMed/NCBI View Article : Google Scholar
3	Yan H, Gong LY, Huang W and Peng YL: Clinical outcomes of small incision lenticule extraction versus femtosecond laser-assisted LASIK for myopia: A Meta-analysis. Int J Ophthalmol. 10:1436–1445. 2017.PubMed/NCBI View Article : Google Scholar
4	Wang D, Liu M, Chen Y, Zhang X, Xu Y, Wang J, To CH and Liu Q: Differences in the corneal biomechanical changes after SMILE and LASIK. J Refract Surg. 30:702–707. 2014.PubMed/NCBI View Article : Google Scholar
5	Shah R, Shah S and Sengupta S: Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg. 37:127–137. 2011.PubMed/NCBI View Article : Google Scholar
6	Chen Y, Yin YW, Zhao Y, Wu XY, Young K, Song WT, Xia XB and Wen D: Differentiation of human embryonic stem cells derived mesenchymal stem cells into corneal epithelial cells after being seeded on decellularized SMILE-derived lenticules. Int J Ophthalmol. 12:717–724. 2019.PubMed/NCBI View Article : Google Scholar
7	Soong HK and Malta JB: Femtosecond lasers in ophthalmology. Am J Ophthalmol. 147:189–197.e2. 2009.PubMed/NCBI View Article : Google Scholar
8	Sumioka T, Miyamoto T, Takatsuki R, Okada Y, Yamanaka O and Saika S: Histological analysis of a cornea following experimental femtosecond laser ablation. Cornea. 33 (Suppl 11):S19–S24. 2014.PubMed/NCBI View Article : Google Scholar
9	Miao H, He L, Shen Y, Li M, Yu Y and Zhou X: Optical quality and intraocular scattering after femtosecond laser small incision lenticule extraction. J Refract Surg. 30:296–302. 2014.PubMed/NCBI View Article : Google Scholar
10	Heichel J, Blum M, Duncker GI, Sietmann R and Kunert KS: Surface quality of porcine corneal lenticules after Femtosecond Lenticule Extraction. Ophthalmic Res. 46:107–112. 2011.PubMed/NCBI View Article : Google Scholar
11	Cheng YY, Kang SJ, Grossniklaus HE, Pels E, Duimel HJ, Frederik PM, Hendrikse F and Nuijts RM: Histologic evaluation of human posterior lamellar discs for femtosecond laser Descemet's stripping endothelial keratoplasty. Cornea. 28:73–79. 2009.PubMed/NCBI View Article : Google Scholar
12	Yoo SH and Hurmeric V: Femtosecond laser-assisted keratoplasty. Am J Ophthalmol. 151:189–191. 2011.PubMed/NCBI View Article : Google Scholar
13	Chamberlain WD, Rush SW, Mathers WD, Cabezas M and Fraunfelder FW: Comparison of femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty. Ophthalmology. 118:486–491. 2011.PubMed/NCBI View Article : Google Scholar
14	Zhao J, Shang J, Niu L, Xu H, Yang D, Zhao Y, Fu D and Zhou X: Two-year outcome of an eye that underwent hyperopic LASIK following inadvertent myopic SMILE lenticule in situ implantation. BMC Ophthalmol. 19(176)2019.PubMed/NCBI View Article : Google Scholar
15	Jin H, He M, Liu H and Zhong X, Wu J, Liu L, Ding H, Zhang C and Zhong X: Small-incision femtosecond laser-assisted intracorneal concave lenticule implantation in patients with keratoconus. Cornea. 38:446–453. 2019.PubMed/NCBI View Article : Google Scholar
16	Abd Elaziz MS, Zaky AG and El SaebaySarhan AR: Stromal lenticule transplantation for management of corneal perforations; one year results. Graefes Arch Clin Exp Ophthalmol. 255:1179–1184. 2017.PubMed/NCBI View Article : Google Scholar
17	Piñero-Llorens DP, Murueta-Goyena Larrañaga A and Hanneken L: Visual outcomes and complications of small-incision lenticule extraction: A review. Exp Rev Ophthalmol. 11:59–75. 2016.
18	Ang M, Chaurasia SS, Angunawela RI, Poh R, Riau A, Tan D and Mehta JS: Femtosecond lenticule extraction (FLEx): Clinical results, interface evaluation, and intraocular pressure variation. Invest Ophthalmol Vis Sci. 53:1414–1421. 2012.PubMed/NCBI View Article : Google Scholar
19	Zhao J, Miao H, Han T, Shen Y, Zhao Y, Sun L and Zhou X: A Pilot Study of SMILE for Hyperopia: Corneal Morphology and Surface Characteristics of Concave Lenticules in Human Donor Eyes. J Refract Surg. 32:713–716. 2016.PubMed/NCBI View Article : Google Scholar
20	Sugar A: Ultrafast (femtosecond) laser refractive surgery. Curr Opin Ophthalmol. 13:246–249. 2002.PubMed/NCBI View Article : Google Scholar
21	Vossmerbaeumer U and Jonas JB: Structure of intracorneal femtosecond laser pulse effects in conical incision profiles. Graefes Arch Clin Exp Ophthalmol. 246:1017–1020. 2008.PubMed/NCBI View Article : Google Scholar
22	Kaiserman I, Maresky HS, Bahar I and Rootman DS: Incidence, possible risk factors, and potential effects of an opaque bubble layer created by a femtosecond laser. J Cataract Refract Surg. 34:417–423. 2008.PubMed/NCBI View Article : Google Scholar
23	Kanellopoulos AJ and Asimellis G: Digital analysis of flap parameter accuracy and objective assessment of opaque bubble layer in femtosecond laser-assisted LASIK: A novel technique. Clin Ophthalmol. 7:343–351. 2013.PubMed/NCBI View Article : Google Scholar
24	Hurmeric V, Yoo SH, Fishler J, Chang VS, Wang J and Culbertson WW: In vivo structural characteristics of the femtosecond LASIK-induced opaque bubble layers with ultrahigh-resolution SD-OCT. Ophthalmic Surg Lasers Imaging. 41 (Suppl):S109–S113. 2010.PubMed/NCBI View Article : Google Scholar
25	Winkler M, Chai D, Kriling S, Nien CJ, Brown DJ, Jester B, Juhasz T and Jester JV: Nonlinear optical macroscopic assessment of 3-D corneal collagen organization and axial biomechanics. Invest Ophthalmol Vis Sci. 52:8818–8827. 2011.PubMed/NCBI View Article : Google Scholar
26	Kunert KS, Blum M, Duncker GI, Sietmann R and Heichel J: Surface quality of human corneal lenticules after femtosecond laser surgery for myopia comparing different laser parameters. Graefes Arch Clin Exp Ophthalmol. 249:1417–1424. 2011.PubMed/NCBI View Article : Google Scholar
27	Serrao S, Buratto L, Lombardo G, De Santo MP, Ducoli P and Lombardo M: Optimal parameters to improve the interface quality of the flap bed in femtosecond laser-assisted laser in situ keratomileusis. J Cataract Refract Surg. 38:1453–1459. 2012.PubMed/NCBI View Article : Google Scholar
28	Winkler von Mohrenfels C, Khoramnia R, Maier MM, Pfäffl W, Hölzlwimmer G and Lohmann C: Cut quality of a new femtosecond laser system. Klin Monatsbl Augenheilkd. 226:470–474. 2009.PubMed/NCBI View Article : Google Scholar : (In German).
29	Sarayba MA, Maguen E, Salz J, Rabinowitz Y and Ignacio TS: Femtosecond laser keratome creation of partial thickness donor corneal buttons for lamellar keratoplasty. J Refract Surg. 23:58–65. 2007.PubMed/NCBI
30	Riau AK, Angunawela RI, Chaurasia SS, Tan DT and Mehta JS: Effect of different femtosecond laser-firing patterns on collagen disruption during refractive lenticule extraction. J Cataract Refract Surg. 38:1467–1475. 2012.PubMed/NCBI View Article : Google Scholar
31	Weng S, Liu M, Yang X, Liu F, Zhou Y, Lin H and Liu Q: Evaluation of Human Corneal Lenticule Quality After SMILE With Different Cap Thicknesses Using Scanning Electron Microscopy. Cornea. 37:59–65. 2018.PubMed/NCBI View Article : Google Scholar
32	Zhang C, Bald M, Tang M, Li Y and Huang D: Interface quality of different corneal lamellar-cut depths for femtosecond laser-assisted lamellar anterior keratoplasty. J Cataract Refract Surg. 41:827–835. 2015.PubMed/NCBI View Article : Google Scholar
33	Soong HK, Mian S, Abbasi O and Juhasz T: Femtosecond laser-assisted posterior lamellar keratoplasty: Initial studies of surgical technique in eye bank eyes. Ophthalmology. 112:44–49. 2005.PubMed/NCBI View Article : Google Scholar
34	Zhao Y, Li M, Sun L, Zhao J, Chen Y and Zhou X: Lenticule Quality After Continuous Curvilinear Lenticulerrhexis in SMILE Evaluated With Scanning Electron Microscopy. J Refract Surg. 31:732–735. 2015.PubMed/NCBI View Article : Google Scholar
35	Lombardo M, De Santo MP, Lombardo G, Schiano Lomoriello D, Desiderio G, Ducoli P, Barberi R and Serrao S: Surface quality of femtosecond dissected posterior human corneal stroma investigated with atomic force microscopy. Cornea. 31:1369–1375. 2012.PubMed/NCBI View Article : Google Scholar
36	Ziebarth NM, Lorenzo MA, Chow J, Cabot F, Spooner GJ, Dishler J, Hjortdal JØ and Yoo SH: Surface quality of human corneal lenticules after SMILE assessed using environmental scanning electron microscopy. J Refract Surg. 30:388–393. 2014.PubMed/NCBI View Article : Google Scholar
37	Aoki S, Murata H, Matsuura M, Fujino Y, Nakakura S, Nakao Y, Kiuchi Y and Asaoka R: The effect of air pulse-driven whole eye motion on the association between corneal hysteresis and glaucomatous visual field progression. Sci Rep. 8(2969)2018.PubMed/NCBI View Article : Google Scholar