Comparing The Incidence Of Transient Light Sensitivity Syndrome (Tlss) After Myopic Smile And Lasik For Myopia And Hyperopia In Over 27,000 Eyes
Published 2022
- 40th Congress of the ESCRS
Reference: FPS07.01
| Type: Free paper
| DOI:
10.82333/s8kw-xe73
Authors:
Dan Reinstein* 1
, Timothy Archer 2
, Ruchi Gupta 2
, Joseph Potter 2
, Robert Yammouni 3
1London Vision Clinic,London,United Kingdom;Columbia University Medical Center,New York,United States;Biomedical Science Research Institute,Ulster University,Coleraine,United Kingdom, 2London Vision Clinic,London,United Kingdom, 3Institute of Optometry,London,United Kingdom
Purpose
To evaluate the incidence of transient light sensitivity syndrome (TLSS) after myopic LASIK, hyperopic LASIK, and myopic SMILE.
Setting
London Vision Clinic, London, UK
Methods
This was a retrospective analysis of consecutive LASIK and SMILE cases performed with the VisuMax femtosecond laser and MEL90 excimer laser (both Carl Zeiss Meditec) between Jan 2010 and Feb 2021. Cases of clinically significant TLSS were identified where anti-inflammatory medications were prescribed between 2 weeks and 6 months after surgery to manage photophobia. The incidence of TLSS was calculated for three groups: myopic LASIK, hyperopic LASIK, and myopic SMILE. The groups were sub-divided by attempted spherical equivalent refraction. The ranges for myopia were 0.00 to -4.00D (Low), -4.00 to -8.00D (Mod), and above -8.00D (High). The ranges for hyperopia were 0.00 to +2.00D (Low), +2.00 to +4.00D (Mod), and above +4.00D (High).
Results
Incidence of TLSS was 2.0% (194/9737) for the SMILE group, 6.4% (575/9018) for the myopic LASIK group, and 10.0% (904/9075) for the hyperopic LASIK group. The difference was statistically significant between all groups (P<.001). For SMILE, incidence of TLSS was similar between sub-groups (P>.05): 2.1% (76/3610) for low, 1.9% (90/4727[TA1] ) for moderate and 1.9% (27/1400) for high myopia. For myopic LASIK, incidence of TLSS increased for higher corrections (P<.001): 5.6% (296/5306) for low, 6.9% (210/3051) for moderate and 10.3% (68/661) for high myopia. For hyperopic LASIK, incidence of TLSS was similar between sub-groups (P>.05): 10.4% (423/4048) for low, 9.5% (356/3745) for moderate and 9.7% (124/1282) for high hyperopia.
Conclusions
The incidence of TLSS was higher after LASIK than SMILE, higher after hyperopic than myopic LASIK, and was “dose-dependent” for myopic LASIK, but did not vary by correction in SMILE. This corresponds to similar energy delivery for all SMILE cases, whereas more excimer ablation leads to more myofibroblast and keratocyte wound healing activation, and hence TLSS. The single femtosecond interface plus excimer ablation results in more TLSS in LASIK than two femtosecond interfaces in SMILE. The incidence of TLSS in hyperopic LASIK did not vary with ablation, implying there is a radiant exposure saturation point above which the incidence does not increase. Low hyperopia ablation volume appears to create an incidence of TLSS equal to high myopia.