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Purpose To compare the corneal epithelial remodeling in eyes with high astigmatism that had small incision lenticule extraction (SMILE) and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK). Methods Seventy-four patients with myopic astigmatism of greater than −2.00 diopters (D) and little binocular difference in spherical equivalent were included in this contralateral comparative study. All patients received SMILE in one eye and FS-LASIK in the other eye randomly. The corneal epithelial remodeling pattern was mapped using the latest RTVue spectral-domain optical coherence tomographer (Optovue) by region. Results Satisfactory refractive correction was achieved in all enrolled eyes with either SMILE or FS-LASIK. The corneal epithelium gradually thickened following surgical cylinder correction, distributing mainly along the flat medium. The corneal epithelium proliferation is milder centrally but more pronounced in the mid-peripheral area after SMILE, compared with FS-LASIK. The flat-steep difference in corneal epithelial thickness (CET) is evident in the mid-peripheral and peripheral areas, which is more obvious in SMILE. Residual cylinder was positively correlated with CET in eyes that had FS-LASIK, but not SMILE. More importantly, these epithelial changes were positively correlated with the ablation depth and higher order aberrations following surgical refractive correction. Conclusions The postoperative CET map varied between SMILE and FS-LASIK. In eyes with high astigmatism, SMILE surgery is followed by milder and more stable corneal epithelial thickening. Moreover, the corneal epithelium is sensitive to stromal ablation and corneal remodeling is crucial to the postoperative visual quality. This study rigorously distinguished the CET difference between SMILE and FS-LASIK in astigmatic eyes and shed light on subsequent research. [J Refract Surg. 2024;40(10);e728–e741.]

Purpose: To compare differences in corneal densitometry (CD) and higher order aberrations (HOAs) in eyes that underwent small incision lenticule extraction (SMILE) and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) for the treatment of myopia and myopic astigmatism at postoperative months 3, 6, and 12, and to evaluate their changes in a separate cohort of eyes after SMILE enhancement. Methods: In this prospective, randomized, paired-eye clinical trial, consecutive eligible participants were randomized to undergo SMILE or FS-LASIK in either eye. Main outcome measures were CD and HOAs preoperatively and at 3, 6, and 12 months postoperatively. A separate cohort of consecutive patients who had SMILE and underwent enhancement were also included for comparison. Results: For CD, no significant differences were found between SMILE and FS-LASIK up to month 12. For HOA measured by wavefront aberrometry, both SMILE and FS-LASIK had an increase in total root mean square (RMS) HOAs, spherical aberration (SA), and vertical coma up to month 12. SMILE had an additional increase in vertical quatrefoil, and FS-LASIK had an increase in horizontal coma at month 12. FS-LASIK had higher SA than SMILE, whereas SMILE had higher vertical quatrefoil than FS-LASIK at month 12. Central and posterior zone CD had significantly decreased after SMILE enhancement compared to after primary SMILE up to 2 years after enhancement. RMS HOAs, lower order aberrations, and SA were all increased after SMILE enhancement compared to after primary SMILE. Conclusions: SMILE induced lower SA but higher vertical quatrefoil than FS-LASIK at 1 year. Both SMILE and FS-LASIK had similar increases in RMS HOAs and vertical coma up to 1 year. There were no differences in CD between both groups. SMILE enhancement additionally had decreased central and posterior CD but greater RMS HOAs and SA compared to primary SMILE. [J Refract Surg. 2024;40(5):e291–e303.]

Myopia is the most common refractive error. Surgical correction with laser is possible. LASIK and SMILE are the techniques currently most used. Aim of the study was to compare changes in corneal volume and thickness after the respective laser treatment. 104 eyes of 52 patients were matched based on refractive error into two equally sized groups, either treated with LASIK or SMILE. Measurements were obtained from the Scheimpflug camera (Pentacam) preoperatively and at 3 and 12 months postoperatively. 3 months postoperatively, the flapless SMILE procedure resulted in a significant overall greater loss of corneal volume (P < 0.01) and corneal thickness (P < 0.01) compared to LASIK. No significant difference was found when comparing the 3 to 12-months values in each group. Within the currently used ranges of refractive error correction, loss in central corneal thickness and corneal volume with SMILE is higher in comparison to LASIK. As greater loss in corneal volume and thickness might contribute to higher level of corneal instability maximum ranges of refractive error correction with SMILE should not supersede those set currently for LASIK until more long-term results on corneal ectasia are available for SMILE.

Background Kidney stone disease is a common problem. The holmium: yttrium–aluminum–garnet (HO:YAG) laser is currently the gold standard laser for ureterorenoscopic (URS) lithotripsy. Recently, the superpulse thulium fiber laser (SP TFL) has shown potential as a substitute for the HO:YAG laser. We aim to compare and evaluate the clinical efficacy and safety of the HO:YAG laser and SP TFL in the treatment of upper urinary calculi in this trial. Methods In this randomized, positive control, blinded management, single-center clinical study, patients with upper urinary calculi will be randomized (1:1) to the experimental group (SP TFL group) or the control group (HO:YAG laser group). Patients in both groups will undergo URS lithotripsy under general anesthesia, and according to the results of randomization, the patients will be treated with an SP TFL (trial group) or a holmium laser (control group). The primary outcome is the stone-free rate at 30 ± 7 days after surgery. The secondary outcomes include the duration of surgery, the duration of laser use, the length of postoperative hospital stay, postoperative clinical indicators, total hospitalization costs, the second-stage stone clearance rate, perioperative complications, the average hemoglobin change, and the mean white blood cell count change. Discussion This study aims to evaluate and compare the clinical efficacy and safety of the SP TFL and HO:YAG for URS lithotripsy in the treatment of upper urinary calculi. Trial registration {2a and 2b} chictr.org.cn ChiCTR2300076893. Registered on October 24, 2023, with ChiCTR ( https://www.chictr.org.cn/bin/project/edit?pid=206827 ). Protocol version {3} August 15, 2023 (V.20230815).

To investigate the feasibility of conventional (basketing + dusting) and Moses (pop-dusting) holmium lasers during flexible ureteroscopy (FURS) in the treatment of 2–3 cm renal calculi and to compare the efficiency and safety of the two methods, a total of 230 patients with 2–3 cm kidney stones who underwent FURS were randomly divided into the conventional group and the Moses group. The mode of lithotripsy in the conventional group was fragmentation and dusting. The mode of lithotripsy in the Moses group was dusting and pop-dusting. Clinical and perioperative variables and complications were compared between the two cohorts. Multivariate analyses of factors contributing to the stone-free rate (SFR) and operation time were performed. No statistically significant differences were found in the demographics, renal stone-related data, SFR, or complications between the cohorts. The laser energy was higher in the Moses cohort than in the conventional cohort (119.3 ± 15.2 vs. 92.8 ± 15.1 kJ; P < 0.001), and the operation time was shorter in the Moses cohort than in the conventional cohort (99.5 ± 18.9 vs. 105.3 ± 13.7 min; P = 0.009). When there was isolated stone, the operation time was shorter in the Moses cohort than in the conventional cohort (99.6 ± 17.5 vs. 111.4 ± 10.7 min; P < 0.001), while there was no significant difference between the two cohorts when there were multiple stones (99.5 ± 20 vs. 101.2 ± 14 min; P = 0.415). Multivariate analyses found that an increase in stone volume can decrease the SFR and prolong the operation time, and use of a Moses laser can shorten the operation time. Both holmium laser modes during FURS can effectively treat 2–3 cm renal calculi. The Moses mode is recommended as the first choice for the treatment of isolated 2–3 cm renal stones. When treating multiple stones, the efficiency of these two laser modalities is the same.Trial registrationChiCTR2200056091

IntroductionThe aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium–aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 μm and 200 μm).MethodsA prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 μm; (2) SP TFL with 200-μm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-μm fiber.ResultsNinety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-μm fiber (34 patients) and a 200-μm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-μm SP TFL group was 9.2 (6.2–14.6) min, in 150-μm SP TFL—11.4 (7.7–14.9) min (p = 0.390), in Ho:YAG—14.1 (10.8–18.1) min (p = 0.021). The total energy consumed in 200-μm SP TFL was 8.4 (5.8–15.2) kJ; 150-μm SP TFL − 10.8 (7.3–13.5) kJ (p = 0.626) and in Ho:YAG—15.2 (11.1–25.3) kJ (p = 0.005).ConclusionsIrrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG.

Introduction The use of lasers has created a major impact in the management of stones. The aim of our study is to evaluate and compare the effectiveness and safety profile of Thulium fiber laser (TFL) and Holmium: YAG (Ho: YAG) laser in ureteric stones. Methods It is a prospective randomized single-centre study carried out from December 2022 to December 2023. About 110 patients were subjected to the study with 55 randomized to each group. All underwent ureterorenoscopic lithotripsy either with TFL or Ho: YAG laser. Patient demographic data, stone-related factors, and complications were analyzed in both groups and compared. Results Mean stone volume was comparable in the Ho: YAG laser and TFL group (578.62 [SD 296.48] mm 3 vs. 556.64 [SD 246.18] mm 3 ; P  = 0.67). Mean total operative time was significantly different between the two groups (Ho: YAG − 27.3 (SD 2.77) vs. TFL − 24.8 (SD 2.58) minutes, P  = 0.005). Mean lasing time was also found to be significantly different (Ho: YAG − 15.16 (SD 3.97) vs. TFL − 13.13 (SD 3.21) minutes, P  = 0.004). Ablation speed was also significantly different (Ho: YAG mean 35.67 (SD 9.13) vs. TFL mean 40.48 (SD 10.60) mm 3 /min, P =  0.012). Stone-free rates (SFR) at 3 months follow-up were similar in TFL and Ho: YAG laser group. Conclusions Shorter lasing time, decreased overall operative time, and higher ablation speed are a few selective advantages of TFL over Ho: YAG laser. The SFR and complication rates remained almost the same in both.

This study aims to compare the efficacy of ureteroscopy with holmium laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) in treating ureteral calculus (UC). We enrolled 86 patients with UC treated in our urology department from November 2020 to November 2022. Group A (n=43) underwent ureteroscopic holmium laser lithotripsy, while Group B (n=43) received ESWL. We recorded treatment duration, post-treatment hematuria duration, and post-treatment stone clearance rates. Renal function and stress response were assessed before and 3 days after treatment. Post-treatment complications were documented, and patient quality of life was evaluated using the SF-36 health questionnaire. Group A exhibited significantly shorter treatment and post-treatment hematuria durations compared to Group B (P < .05). In stones >1 cm, group A demonstrated a higher clearance rate (P < .05). Post-treatment, Group A showed improved renal function and lower stress response (P < .05). The incidence of post-treatment complications did not differ significantly between groups (P > .05), but SF-36 scores were higher in Group A (P < .05). Ureteroscopy with holmium laser lithotripsy proves effective in UC treatment, contributing to a shortened recovery period and enhanced patient quality of life.

Purpose To investigate long-term corneal biomechanical changes in thin corneas after small incision lenticule extraction (SMILE). Methods Patients with indications for SMILE were enrolled in this study between November 2017 and March 2018. Patients were matched for age, spherical diopter, cylinder, spherical equivalent (SE), and lenticule thickness (LT), and then categorized into the thin cornea group (preoperative thinnest central corneal thickness [CCT] of 500 µm or less, 32 eyes) or normal cornea group (CCT of greater than 500 µm, 32 eyes). Corneal biomechanical properties were measured using the Corvis ST system. Data were collected at 1 day, 3 weeks, 3 months, and 3 years postoperatively. Results At 3 years postoperatively, the safety indexes were 1.06 ± 0.12 and 1.09 ± 0.12 (P = .23) in the thin cornea and normal groups, respectively; the respective effective indexes were 0.89 ± 0.23 and 0.98 ± 0.18 (P = .12). Recovery of overall corneal stiffness was observed in both groups. Comparative analysis of biomechanical parameters revealed that the change between preoperative and 3-year postoperative values was smaller in the thin cornea than in the normal group, without statistical significance. Correlation analysis showed that SE, LT, and CCT were the main parameters affecting changes in corneal biomechanical properties in the normal group. No significant correlations were found between the stress-strain index, Corvis biomechanical index for laser vision correction, and preoperative CCT or age. Conclusions With rigorous preoperative screening and appropriate surgical design, thin corneas are biomechanically stable in the long term after SMILE. Moreover, postoperative biomechanical strength increases over time. [J Refract Surg. 2025;41(1):e39–e49.]

Background We aimed to evaluate and compare the rise in the temperature for the safety of the kidney parenchyma on firing the Holmium: Yttrium Aluminium Garnet laser and the Thulium Fiber Laser during laser lithotripsy in humans. Method We included 30 pre-stented patients with renal calculi undergoing Retrograde intra-renal surgery. They were randomized into two groups – 15 patients underwent holmium laser lithotripsy and 15 patients underwent TFL laser lithotripsy. We used Philips paediatric esophageal probe to measure rise in temperature on firing holmium or TFL laser with irrigation at 10 ml/min and pressure at 100 mmHg. Different laser settings were used. Result The mean size of the calculi was 0.8 mm. The rise in temperature with holmium and TFL lasers depended on the firing time and irrigation flow, keeping power constant. On continuous firing for 10s, 20s, and 30s, the average rise in temperature went up to 28.67 °C, 29.70 °C, and 37.17 °C with holmium and with TFL it was 28.77 °C, 29.83 °C, and 37.62 °C, respectively. The difference in rise in temperature between two groups was statistically insignificant with p-values > 0.05. The maximum temperature reached with TFL was 39.4 °C with a 30s lasing time, and that with Ho: YAG was 38.9 °C. Conclusions The rise in temperature was almost equivalent with holmium and TFL. Hence, both Ho: YAG and TFL can be safely used in laser lithotripsy. Adequate irrigation is a must during the surgery. The continuous lasing time should be strictly restricted to less than 20s.