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Effects of small incision lenticule extraction and femtosecond laser‑assisted in situ keratomileusis on choroidal thickness and blood flow density in patients with myopia

  • Authors:
    • Shirui Yang
    • Tiantian Qian
    • Min Tang
    • Jing Zhang
    • Jie Hou
    • Yahui Dong
    • Yulin Lei
  • View Affiliations / Copyright

    Affiliations: Department of Ophthalmology, Binzhou Medical University, Binzhou, Shandong 256603, P.R. China, Department of Internal Medicine, Jinan Zhangqiu District People's Hospital, Jinan, Shandong 250200, P.R. China, Department of Ophthalmology, Heze Medical College, Heze, Shandong 274000, P.R. China, Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong 250200, P.R. China
    Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 37
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    Published online on: December 1, 2025
       https://doi.org/10.3892/etm.2025.13032
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Abstract

Corneal refractive surgery is often used to correct myopia, and after surgery attention is often focused on changes in vision and corneal response. However, studies on the posterior segment of the eye remain relatively scarce. The present study aimed to observe changes in choroidal thickness and blood flow density after small incision lenticule extraction (SMILE) and femtosecond laser‑assisted in situ keratomileusis (FS‑LASIK) using optical coherence tomography. Changes in spherical equivalent (SE), axial length (AL), choroidal thickness and choriocapillaris blood flow density were recorded before and after surgery in 35 patients (70 eyes) who underwent SMILE and 21 patients (42 eyes) who underwent FS‑LASIK. Postoperative SE significantly improved in both groups (P<0.05), and AL was shorter than the baseline level (P<0.05). Choroidal thickness initially increased and subsequently decreased to preoperative levels at multiple measurement sites in both groups. No significant changes were observed in choriocapillaris blood flow density in the two groups postoperatively compared with preoperatively. In conclusion, the results indicated that SMILE and FS‑LASIK exert minimal influence on the choroid. To the best of our knowledge, the current study presents one of the first comparative assessments of dynamic choroidal changes following SMILE and FS‑LASIK, offering insights into structural alterations in the posterior segment post‑surgery.
View Figures

Figure 1

Measurement of CT. (A) Imaging of CT
during optical coherence tomography scanning. (B) The scanned area
was divided into different regions in the form of quadrants,
including the following regions: CT-C, CT-N1, CT-N2, CT-T1, CT-T2,
CT-S1, CT-S2, CT-I1 and CT-I2. Numbers 1 to 12 indicate the
positions of the captured images. CT, choroidal thickness; CT-C, CT
at the centre of the macula; CT-N1, CT at 0.5 mm nasal; CT-N2, CT
at 1.5 mm nasal; CT-T1, CT at 0.5 mm temporal; CT-T2, CT at 1.5 mm
temporal; CT-S1, CT at 0.5 mm superior; CT-S2, CT at 1.5 mm
superior; CT-I1, CT at 0.5 mm inferior; CT-I2, CT at 1.5 mm
inferior.

Figure 2

Measurement of CD. (A) Imaging of the
choriocapillaris vessels during optical coherence tomography
scanning. The square in the picture represents the scanning area
used by the instrument to measure blood flow density, and the cross
is the center of the scan. (B) The scanned area was divided into
different regions in the form of quadrants, including the following
regions: CD-C, CD-N, CD-T, CD-S and CD-I. CD, choriocapillaris
blood flow density; CD-C, CD at the centre of the macula; CD-N, CD
at 0.5 mm nasal; CD-T, CD at 0.5 mm temporal; CD-S, CD at 0.5 mm
superior; CD-I, CD at 0.5 mm inferior.

Figure 3

Scatter plot of the correlation
between ΔAL and AD. (A) Scatter plot of the correlation between ΔAL
and AD 3 months postoperatively in the small incision lenticule
extraction group. (B) Scatter plot of the correlation between ΔAL
and AD 3 months postoperatively in the femtosecond laser-assisted
in situ keratomileusis group. ΔAL, amount of axial length
shortening 3 months after surgery; AD, ablation depth.

Figure 4

Change in the trend of CT before and
after the operation in the small incision lenticule extraction
group measured across different regions. Pre, pre-operation; CT,
choroidal thickness; CT-C, CT at the centre of the macula; CT-N1,
CT at 0.5 mm nasal; CT-N2, CT at 1.5 mm nasal; CT-T1, CT at 0.5 mm
temporal; CT-T2, CT at 1.5 mm temporal; CT-S1, CT at 0.5 mm
superior; CT-S2, CT at 1.5 mm superior; CT-I1, CT at 0.5 mm
inferior; CT-I2, CT at 1.5 mm inferior.

Figure 5

Change in the trend of CT before and
after the operation in the femtosecond laser-assisted in
situ keratomileusis group measured across different regions.
Pre, pre-operation; CT, choroidal thickness; CT-C, CT at the centre
of the macula; CT-N1, CT at 0.5 mm nasal; CT-N2, CT at 1.5 mm
nasal; CT-T1, CT at 0.5 mm temporal; CT-T2, CT at 1.5 mm temporal;
CT-S1, CT at 0.5 mm superior; CT-S2, CT at 1.5 mm superior; CT-I1,
CT at 0.5 mm inferior; CT-I2, CT at 1.5 mm inferior.
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Spandidos Publications style
Yang S, Qian T, Tang M, Zhang J, Hou J, Dong Y and Lei Y: Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia. Exp Ther Med 31: 37, 2026.
APA
Yang, S., Qian, T., Tang, M., Zhang, J., Hou, J., Dong, Y., & Lei, Y. (2026). Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia. Experimental and Therapeutic Medicine, 31, 37. https://doi.org/10.3892/etm.2025.13032
MLA
Yang, S., Qian, T., Tang, M., Zhang, J., Hou, J., Dong, Y., Lei, Y."Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia". Experimental and Therapeutic Medicine 31.2 (2026): 37.
Chicago
Yang, S., Qian, T., Tang, M., Zhang, J., Hou, J., Dong, Y., Lei, Y."Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia". Experimental and Therapeutic Medicine 31, no. 2 (2026): 37. https://doi.org/10.3892/etm.2025.13032
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Spandidos Publications style
Yang S, Qian T, Tang M, Zhang J, Hou J, Dong Y and Lei Y: Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia. Exp Ther Med 31: 37, 2026.
APA
Yang, S., Qian, T., Tang, M., Zhang, J., Hou, J., Dong, Y., & Lei, Y. (2026). Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia. Experimental and Therapeutic Medicine, 31, 37. https://doi.org/10.3892/etm.2025.13032
MLA
Yang, S., Qian, T., Tang, M., Zhang, J., Hou, J., Dong, Y., Lei, Y."Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia". Experimental and Therapeutic Medicine 31.2 (2026): 37.
Chicago
Yang, S., Qian, T., Tang, M., Zhang, J., Hou, J., Dong, Y., Lei, Y."Effects of small incision lenticule extraction and femtosecond laser‑assisted <em>in situ</em> keratomileusis on choroidal thickness and blood flow density in patients with myopia". Experimental and Therapeutic Medicine 31, no. 2 (2026): 37. https://doi.org/10.3892/etm.2025.13032
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