Impressive Results with VisuMax 800

Upgraded laser system delivers good results in SMILE procedures. Dermot McGrath reports from the ESCRS Virtual Winter Meeting 2022

Small incision lenticule extraction (SMILE) with a new enhanced laser platform proved an effective and safe refractive corneal procedure and provided predictable and stable correction of myopia and myopic astigmatism, according to a recent study.

“Our initial results performing SMILE with the VisuMax® 800 (Carl Zeiss Meditec) demonstrated very good results in terms of visual acuity, efficacy, and safety. No eyes had more than one line loss of corrected-distance visual acuity (CDVA), demonstrating a good safety profile. The quality of vision and interface clarity also showed a minimal increase in scatter, which is expected to improve over time,” Supriya Sriganesh MD told a Cornea Day session.

Compared to previous versions of the laser, the VisuMax 800 incorporates a faster laser source, enabling the user to cut a complete lenticule in approximately 8 to 10 seconds.

“This means a shorter suction time and, therefore, [lower] risk of suction loss. The VisuMax 800 features computer-assisted centration as well as cyclotorsion adjustment by digital rotation of the cutting pattern. In addition, the new laser has a smaller footprint and therefore needs less space in the operating room,” Dr Sriganesh explained.

Additionally, the VisuMax 800 is now fully integrated into the refractive workflow and offers enhanced cyclotorsion control.

“The laser is connected via ZEISS FORUM® with other devices such as the Pentacam® (OCULUS) and MEL® 90 excimer laser (Carl Zeiss Meditec), which allows remote planning of the surgical procedures. The OcuLign pattern rotation for cyclotorsion alignment automatically recalculates the treatment pattern and helps counter any cyclotorsion that may occur,” she said.

The study data presented by Dr Sriganesh included 180 eyes operated using the new system, out of which 136 eyes were available for the two-week follow-up evaluation. The mean patient age was 27 years. Mean preoperative sphere was -3.90 D, cylinder was -0.99 D, and spherical equivalent (SE) was -4.39 D. The preoperative mean Ocular Scatter Index (OSI) reading was 0.57.

The key postoperative parameters at 15 days showed a mean uncorrected distance visual acuity (UCDVA) of -0.08 D (logMAR), with a mean sphere of 0.001 D and a mean cylinder of -0.02. The mean spherical equivalent was -0.01 D. The mean OSI changed from postoperative day one mean of 1.23 to 0.77 by day 15.

Efficacy, as determined by preoperative CDVA versus the postoperative UDVA, was very good, Dr Sriganesh reported.

“The results were impressive, with 100% of eyes 6/9 or better at two weeks and 99% of eyes 6/6 or better at two weeks. The efficacy index was 1.0,” she said.

Safety outcomes were also very good, with 66% of eyes recording unchanged CDVA, while 22% of eyes gained one line of vision and 11% of eyes lost one line. The safety index was 1.01.

Predictability was also impressive, said Dr Sriganesh, with 95% of eyes within 0.25 D of target refraction and 100% of eyes within 0.5 D at the two-week follow-up point.

“When we look at the predictability graph showing attempted versus achieved change in spherical equivalent, the average deviation is only -0.01 D, which is excellent,” she said.

Supriya Sriganesh MD practices at the Nethradhama Super Specialty Eye Hospital, Bengaluru, India. samak.supriya@gmail.com

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