ESCRS - PP21.03 - Novel App Based Decision Making Algorithm For Smile Xtra Procedure (Need Xtra App)

Novel App Based Decision Making Algorithm For Smile Xtra Procedure (Need Xtra App)

Published 2023 - 41st Congress of the ESCRS

Reference: PP21.03 | Type: Free paper | DOI: 10.82333/tjvk-nd38

Authors: Anushree Anil Bhatkal* 1 , Rohit Shetty 2 , Pooja Khamar 1 , Mathew Francis 3

1Cataract and Refractive Services,Narayana Nethralaya,Bengaluru,India, 2Cornea and Refractive Services,Narayana Nethralaya,Bengaluru,India, 3IBMS,GROW Laboratories,Narayana Nethralaya,Bengaluru,India

Purpose

Despite Laser in situ keratomileusis (LASIK) being one of the most commonly performed refractive surgery procedures, patients with high refractive errors with borderline topographies, carry a high risk of ectasia in future. Commonly, procedures like  Photorefractive keratectomy(PRK) , Small incision lenticule extraction(SMILE), SMILE Xtra and phakic Intraocular lens (p-IOL) are indicated in such patients. However, there is a lack of clear guidelines which can help the surgeon decide the correct surgery in patients with borderline parameters. Using various parameters we developed a scoring system incorporated into an application based upon which a surgeon could decide an appropriate procedure. 

Setting

Narayana Nethralaya(tertiary eye care teaching hospital), Bengaluru, Karnataka, India.

Methods

The app was built using following parameters:Novel Indices (N) from corneal tomography,Epithelium thickness and pattern(E),Emerging novel indices (E) from corneal biomechanics, aberration profile and Discordant symptoms (D) pertaining to poor ocular surface health.The NEED algorithm was realized into a working software using LabVIEW 2018 SP1 professional development system (National Instruments Corp,USA).We included 40 patients and the surgical decision making was made on the basis of the app.17 patients underwent SMILE Xtra,9 patients underwent SMILE,8 patients underwent PRK and 6 underwent p-IOL surgery.We followed up the patient on post operative day 1 & 1,3,6 months and 1 year after surgery to assess post operative refractive stability.

Results

Patients undergoing surgery as per the decision made by the app showed a long term stability on pentacam at 1 year post operative follow up. There was no evidence of ectasia or regression in any of the patients. The visual outcomes were satisfactory with a majority of patients having 20/20 visual acuity even at 1 month.

Conclusions

The NEED Xtra app promises a user friendly approach while deciding surgeries for patients with borderline parameters. It is simple to use and not time consuming. It eliminates any confusion that may be there regarding surgical decision making in such patients.