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In vivo and ex vivo evaluation of corneal inflammatory response and apoptosis induced after SMILE procedures for different refractive error range

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Session Details

Session Title: Femtosecond Small Lenticule Extraction II

Session Date/Time: Tuesday 08/09/2015 | 16:30-18:30

Paper Time: 17:56

Venue: Room 17

First Author: : R.Calienno ITALY

Co Author(s): :    C. Curcio   M. Lanzini   N. Salgari   M. Nubile   R. Turilli   L. Mastropasqua     

Abstract Details


To detect, respectively in vivo by means of corneal confocal microscopy (IVCM) and in vitro by immunohistochemistry, corneal inflammation and apoptosis induced after small incision lenticule extraction (SMILE) at different refractive correction from medium to moderate and high value of myopia.


Non interventional nonrandom prospective single-blinded study design. SS Annunziata hospital, Chieti, Italy


50 eyes of 50 patients underwent SMILE due to a medium to high myopia (spherical equivalent refraction from -3.75 to -10.00 diopters (D) with refractive astigmatism under -0.75 D). After treatments, all corneal lenticules were checked for regularity and wholeness then fixed in formalin for immunohistochemistry evaluation of positivity for TUNEL and cd11b to determine the tissue induced apoptosis and inflammation levels. On the first week, 1 and 3 months after surgery, patients returned for IVCM examination to analyze a corneal stromal femtosecond laser treatment interfaces reflectivity by measuring the mean gray value of the reflective particles using ImageJ software


No correlation was observed between treated myopic refractive error and number of cells expressing CD11b antigen in all samples analyzed. Also for TUNEL expression no positive correlation was found between number of TUNEL positive cells and treated refractive error. IVCM showed at 1 week and 1 month of follow up numerous reflective particles at the laser treatment interface with a moderate light-scattering. In semiquantitative analysis of reflectivity intensity at the laser interfaces no statistical difference was found in backscattering among different treated myopic errors between 1 week and 3 month and between 1 month and 3 months (respectively p= 0.0960 and p= 0.5666). A statistical correlation was evident only between 1 week and 1 month (p=0.0213).


Inflammation and apoptosis levels may strongly affect the refractive and clinical success of a refractive surgical procedure. SMILE, as an innovative all-femto surgical procedure, demonstrates itself to involve a reduced tissue inflammation and apoptosis levels with a minimum tissue response, in terms of interface reflectivity, without statistically significant differences among variable treated refractive error range.

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