BACKGROUND AND AIMS: Refractive eye surgery is a rapidly expanding field of ophthalmology and corneal surgery is undergoing constant development leading to less invasive technologies. The goal of this study was to compare the most common femtoLASIK surgery with the newer ReLEx SMILE surgery which is gentler to the cornea. The comparison was made in terms of dioptric error reduction. METHODS: The studied cohort of patients consisted of two major groups: 30 patients who underwent femtoLASIK surgery and 30 who underwent ReLEx SMILE surgery. -30 patients, 60 eyes. All patients were aged 18-45 years with moderate myopia or astigmatism ranging from -3.25 to -6.0 spherical diopters and from 0 to -1.0 cylindrical diopters. In all, the best corrected visual acuity measured prior to surgery was 1.0. Pachymetry was not comparable because each surgical method was performed at a different time point and the introduction of an innovative method into practice led to a change in selection criteria. RESULTS: During postsurgical check-ups, the ReLEx SMILE method (0.74) led to lower values of non-corrected visual acuity compared to the femtoLASIK method (0.88), (P<0.001). However, the results changed at the one-year post-surgery check-up, when ReLEX SMILE patients achieved non-corrected visual acuity of 0.97 compared to femtoLASIK patients, who scored 0.83, (P=0.007). Based on data analysis from the automatic refractometer, the average spherical diopters of the femtoLASIK (-0.32 D) were higher than those of the ReLEx SMILE (-0.07 D), (P<0.001). The results for the cylindrical diopters were also significant, (P=0.021). When we compared the spherical equivalent one year after surgery, the difference between methods was significant. The FemtoLASIK method resulted in an average SE -0.55 D compared to -0.09 D for the ReLEx SMILE method, (P<0.001). CONCLUSION: This study showed that there was a significant difference in results between the two surgical methods of treatment of moderate myopia and astigmatism, in terms of regression of dioptric error, as well as in achievement and maintenance of visual acuity during the observed period. The ReLEx SMILE had better results.

• Klíčová slova
• FemtoLASIK, ReLEx SMILE,
• MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• pooperační komplikace MeSH
• refrakční chirurgické výkony * metody   MeSH
• refrakční vady terapie   MeSH
• rohovka * chirurgie   patologie   MeSH
• zraková ostrost MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The aim of our presentation is to introduce future eye bank product - corneal stromal lenticule from living donors, which can be used for allotransplantation. METHODS: ReLEx (refractive lenticule extraction) SMILE (small incision lenticule extraction) is a common approach in laser eye surgery. It is minimally invasive and flap-free procedure. During this procedure part of corneal stroma (lenticule) is created by femtosecond laser and consequently removed through small incision. The lenticule is basically waste material of the ReLEx SMILE procedure. In the International Eye Bank of Prague, we decided to establish new protocol for lenticule withdrawal, storage and release for transplantation. RESULTS: All donors signed an informed consent, and their serum was tested for the presence of infectious diseases. After ReLEx SMILE procedure the lenticule was stored in container with cryopreservation solution and frozen in the eye bank using the same protocol for frozen amniotic membrane. After 6 months in -80°C tissues were defrosted and examined histologically, using conventional light histology staining and electron microscopy. CONCLUSION: We believe, that lenticule from living donor is a safe and effective tissue, that can be used for many indications and in particular situations represents good alternative to whole donor cornea and amniotic membrane.

• MeSH
• lidé MeSH
• oční banky * MeSH
• rohovka MeSH
• stroma rohovky * chirurgie   MeSH
• usmívání se MeSH
• žijící dárci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Cíl práce: Porovnat vliv refrakční metody LASIK a ReLEx SMILE na osmolaritu slzMetodika: Prospektivní nerandomizovaná srovnávací studie. Zhodnotili jsme výsledky ve dvou skupinách pacientů, kteří podstoupili oboustranný refrakční zákrok k odstranění myopie a případně astigmatismu na oční klinice Horní Počernice. Každá skupina byla tvořena 15 pacienty (30 očí), pacienti jedné skupiny podstoupili refrakční zákrok typu FS-LASIK, ve druhé skupině operaci typu ReLEx SMILE. U všech pacientů bylo provedeno oboustranné měření osmolarity slzného filmu pomocí přístroje TearLab v den operace, dále první den po operaci, měsíc a 3 měsíce po operaci.Výsledky: Průměrná předoperační hodnota osmolarity slzného filmu byla v obou skupinách prakticky stejná, ve skupině ReLEx SMILE 294,9 ? 13,4 mOsm/l a ve skupině FS-LASIK 296,4 ? 13,1. Měsíc a 3 měsíce po operace se zvýšila tato hodnota na 301,4 respektive 296,4 ? 13,3 mOsm/l ve skupině ReLEx SMILE, přičemž vzestup hodnot měsíc po operaci byl statisticky signifikantní. Ve skupině pacientů po FS-LASIK byla měsíc po operaci osmolarita 320,1 ? 14,7, 3 měsíce po operaci 306,5 ? 13,1 mOsm/l. Obě tyto hodnoty ve srovnání s předoperační hodnotou byly statisticky významně vyšší. Vzestup průměrných hodnot osmolarity byl měsíc po operaci statisticky významně vyšší ve skupině pacientů po FS-LASIK ve srovnání s hodnotami u pacientů po ReLEx SMILE. 3 měsíce po operaci již nebyl rozdíl mezi skupinami statisticky významný.Závěr: V našem souboru pacientů po provedeném refrakčním zákroku FS-LASIK jsme zaregistrovali vyšší průměrnou hodnotu osmolarity slzného filmu ve srovnání s pacienty po zákroku typu ReLEx SMILE, a to ve všech sledovaných obdobích (1 den, 1 měsíc a 3 měsíce po operaci). Zákrok typu ReLEx SMILE považujeme za metodu s menším vlivem na kvalitu slzného filmu, s rychlejším návratem k původním hodnotám osmolarity a potenciálně vyšším komfortem pro pacienta.

Purpose: To compare the influence of the LASIK and ReLEx SMILE refractive method on tear osmolarityMethods: Prospective non-randomized comparative study. We evaluated the results in two groups of patients who underwent binocular refractive surgery to remove myopia and possibly astigmatism in the eye clinic of Horní Počernice. In each group were 15 patients (30 eyes), patients of one group undergoing FS-LASIK refractive surgery, in the second group a ReLEx SMILE procedure. Bilateral measurement of the tear film osmolarity using the TearLab instrument on the day of surgery, the first day after surgery, one month and 3 months after surgery was performed on each patient.Results: The mean preoperative value of the osmolarity of the tear film was practically the same in both groups, in the ReLEx SMILE group 294.9 ? 13.4 mOsm/l and in the FS-LASIK group 296.4 ? 13.1. One and three months after the surgery in the ReLEx SMILE group, these values increased to 301.4 and 296.4 ? 13.3 mOsm/l respectively, the elevation of values one month after surgery was statistically significant. In the FS-LASIK group, one month after surgery, the osmolarity was 320.1 ? 14.7, three months postoperatively 306.5 ? 13.1 mOsm / l. Both of these values compared to the preoperative value were statistically significantly higher. The increase of the mean osmolarity was statistically significantly higher in the FS-LASIK group compared to the ReLEx SMILE. Three months after surgery, the difference between groups was not statistically significant.Conclusion: In our group of patients, after the FS-LASIK refraction procedure, we noted a higher mean osmolarity of tear film in comparison with patients after the ReLEx SMILE in all evaluated timepoints (1 day, 1 month and 3 months after surgery). We consider ReLEx SMILE as a method with less impact on the quality of tear film, with a faster return to original osmolarity and potentially higher patient comfort.

• Klíčová slova
• ReLEx SMILE, FS-LASIK,
• MeSH
• dospělí MeSH
• hodnocení postupů (zdravotní péče) MeSH
• lidé MeSH
• mladý dospělý MeSH
• osmolární koncentrace * MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• refrakční chirurgické výkony * metody   MeSH
• slzy * MeSH
• syndromy suchého oka etiologie   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH

Purpose: To compare the influence of the LASIK and ReLEx SMILE refractive method on tear osmolarity Methods: Prospective non-randomized comparative study. We evaluated the results in two groups of patients who underwent binocular refractive surgery to remove myopia and possibly astigmatism in the eye clinic of Horní Počernice. In each group were 15 patients (30 eyes), patients of one group undergoing FS-LASIK refractive surgery, in the second group a ReLEx SMILE procedure. Bilateral measurement of the tear film osmolarity using the TearLab instrument on the day of surgery, the first day after surgery, one month and 3 months after surgery was performed on each patient. Results: The mean preoperative value of the osmolarity of the tear film was practically the same in both groups, in the ReLEx SMILE group 294.9 ± 13.4 mOsm/l and in the FS-LASIK group 296.4 ± 13.1. One and three months after the surgery in the ReLEx SMILE group, these values increased to 301.4 and 296.4 ± 13.3 mOsm/l respectively, the elevation of values one month after surgery was statistically significant. In the FS-LASIK group, one month after surgery, the osmolarity was 320.1 ± 14.7, three months postoperatively 306.5 ± 13.1 mOsm / l. Both of these values compared to the preoperative value were statistically significantly higher. The increase of the mean osmolarity was statistically significantly higher in the FS-LASIK group compared to the ReLEx SMILE. Three months after surgery, the difference between groups was not statistically significant. Conclusion: In our group of patients, after the FS-LASIK refraction procedure, we noted a higher mean osmolarity of tear film in comparison with patients after the ReLEx SMILE in all evaluated timepoints (1 day, 1 month and 3 months after surgery). We consider ReLEx SMILE as a method with less impact on the quality of tear film, with a faster return to original osmolarity and potentially higher patient comfort.

• Klíčová slova
• ReLEx SMILE, FS-LASIK,
• MeSH
• dospělí MeSH
• hodnocení postupů (zdravotní péče) MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• osmolární koncentrace * MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• refrakční chirurgické výkony * ekonomika   metody   škodlivé účinky   MeSH
• slzy * chemie   MeSH
• statistika jako téma MeSH
• syndromy suchého oka etiologie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• srovnávací studie MeSH

Corneal stromal lenticule is a part of corneal stroma, which can be created by manual dissection, by femtosecond laser from the donor cornea, but chiefly it is a waste product of a refractive procedure ReLex SMILE (Small Incision Lenticule Extraction). Corneal lenticule has a huge potential in corneal surgery. In recent years, many studies have been published to show the possibility to use this tissue to treat corneal defects, as well as in refractive surgery. Thanks to the quantity of lenticules which arise every day during SMILE operations, this tissue is much more accessible than any other kind of corneal tissue. According to the experience with lenticule implantation in animal models, or even human patients, lenticule implantation is considered safe, reversible method, which is not associated with immune rejection or other severe complications. However, the crucial step before the process of lenticule implantation, is proper preservation of this tissue. Donor corneal tissue containing endothelium is usually preserved in hypothermia and then usable maximally for two weeks. Newer methods such as organ culture storage and use of a sterile cornea prolong the time of usability of the tissue. The possibilities for corneal lenticule storage are theoretically wider thanks to the fact, that we do not need to preserve fragile cellular structures. Besides the storage in hypothermia, other preserving methods such as cryopreservation and storage after decellularization have been tested. This review aimed to examine the current literature that describes possible methods of corneal lenticule preservation. A comprehensive search was created based on articles published in English on PubMed.gov, Cochranelibrary.com and Scopus.com using following keywords: corneal lenticule preservation, corneal lenticule storage, cold storage corneal lenticule, corneal lenticule cryopreservation till 2020.

• MeSH
• hypotermie * MeSH
• kryoprezervace MeSH
• lidé MeSH
• rohovka chirurgie   MeSH
• rohovkový endotel MeSH
• stroma rohovky * chirurgie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: To evaluate changes in corneal refractive parameters after implantation of a stromal lenticule of different thickness. We assume that the refractive outcome depends on the optical power of the used lenticule. METHODS: We conducted an ex-vivo non-human study on 33 normotonic porcine eyeballs divided into two groups, for 4D and 8D human lenticule implantation. Corneal stromal lenticules were obtained as a by-product from a laser procedure ReLEx SMILE. We evaluated corneal refractive parameters measured on Oculus Pentacam© device before and immediately after the intrastromal lenticule implantation. RESULTS: There was no statistically significant difference in corneal refractive parameters between the eyeball groups before lenticule implantation. In both groups, the intrastromal implantation in the depth of 300um led to a significant increase of central corneal pachymetry and corneal anterior steepening. In the 4D group the average central corneal pachymetry increased from 903 ± 124.59 to 1230 ± 148.99 (p = 0.0022) and in 8D group from 733.35 ± 69.60 to 1109 ± 161.64 (p = 0.0008). Induced changes in other studied parameters were not statistically significant, Kmax changed from 45.57 ± 2.78 to 72.07 ± 16.83 (p = 0.0094) and Km front from 40.72 ± 1.60 to 48.87 ± 5.83 (p = 0.0037) in 4D group and in the 8D group average Kmax increased from 42.22 ± 1.54 to 62.95 ± 12.67 (p = 0.0001) and K2 front 40.46 ± 1.64 to 51.51 ± 9.63 (p = 0.0037). There were no significant differences in refractive changes between the 4D and 8D groups after lenticule implantation. CONCLUSION: Intrastromal corneal lenticule implantation induces changes in corneal refractive parameters. In both groups, the implantation induced a significant increase of an anterior corneal steepening without any significant influence on posterior corneal flattening. Corneal lenticule implantation did not lead to any significant change of corneal astigmatism. However, in order to have more precise data for future clinical applications we need to continue with the experiments and verify the results on human corneas.

• MeSH
• laserová chirurgie rohovky * metody   MeSH
• lasery excimerové terapeutické užití   MeSH
• lidé MeSH
• nemoci rohovky * MeSH
• prasata MeSH
• refrakce oka MeSH
• rohovka MeSH
• rohovková topografie MeSH
• stroma rohovky chirurgie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH