Glaucoma is one of the leading causes of irreversible blindness. Pharmacological first-line therapies are limited by poor patient adherence. Selective laser trabeculoplasty (SLT) offers effective reduction of intraocular pressure (IOP). Direct selective laser trabeculoplasty (DSLT) represents an advancement, enabling automated and contactless treatment for the first time. It could become established as the first-line therapy in the future.

Das Glaukom ist eine führende Ursache für irreversible Erblindung. Medikamentöse Erstlinientherapien sind durch geringe Patientenadhärenz limitiert. Die selektive Lasertrabekuloplastik (SLT) bietet eine effektive intraokulare Druck (IOD-)Senkung. Die direkte selektive Lasertrabekuloplastik (DSLT) stellt eine Weiterentwicklung dar und ermöglicht erstmals eine automatisierte und kontaktlose Behandlung. Möglicherweise etabliert sie sich in Zukunft als Erstlinientherapie.

Purpose:To compare the accuracy of toric intraocular lens (IOL) alignment between femtosecond laser-assisted capsular marking and digital marking. Setting:Ruhr University Eye Clinic, Bochum, Germany. Design:Prospective clinical trial. Methods:In this study, 28 eyes of 23 patients, who underwent femtosecond laser-assisted cataract surgery with implantation of a toric IOL, were included. Intraoperatively, both femtosecond laser-assisted capsular marking and digital marking were applied simultaneously and compared in every case. The toric IOL was aligned to the capsular markings. Postoperatively, the axis of the capsular markings and toric IOL alignment was examined. Visual acuity and refractive outcomes were evaluated. Results:Both alignment methods were performed without intraoperative complications in all cases. 25 eyes were included in the final analysis. Misalignment was significantly lower with femtosecond laser-assisted capsular marking than with digital marking (1.71 +/- 1.25 degrees vs 2.64 +/- 1.70 degrees, P = .016). Deviation from the target axis of the toric IOL was 1.62 +/- 1.24 degrees 4 to 6 weeks postoperatively. Postoperative uncorrected distance visual acuity was 0.14 +/- 0.13 logMAR, and residual astigmatism was 0.3 +/- 0.23 diopter (D) with an astigmatism <= 0.5 D in 93% of eyes. Conclusions:Both methods showed excellent results for the alignment of toric IOLs. However, femtosecond laser-assisted capsular marking was significantly more precise than digital marking and showed good refractive results. In addition, capsular marking offers the possibility to avoid parallax error and evaluating postoperative IOL rotation.

Purpose: To evaluate the long-term safety and efficacy of primary posterior laser capsulotomy (PPLC) as a new method to prevent posterior capsule opacification (PCO). Setting: University Eye Hospital Bochum, Bochum, Germany. Design: Prospective randomized intraindividual comparative trial. Methods: 16 patients were examined two years after cataract surgery in both eyes. In one eye routine cataract surgery and a PPLC (PPLC group) were performed. In the other eye only routine cataract surgery (Control group) was done. For the PPLC, the posterior capsule between the anterior hyaloid surface and the optic surface of the IOL was identified with integrated 3-dimensional spectral-domain optical coherence tomography and treated with a femtosecond second laser. The main outcome measures were safety parameters such as intraocular pressure, macular thickness and volume, correct visual acuity, and the formation of PCO in both groups. Results: No significant difference was measured between the groups in intraocular pressure, endothelial cell count and macular thickness. Two eyes of the control group had Nd:YAG laser capsulotomy and were excluded from the PCO analysis. In the PPLC group the total PCO score was significant lower in comparison to the control group (0.04, SD: 0.08 to 0.26, SD: 0.31; p value 0.06). The central area of the IOL optic demonstrated no PCO in all eyes of the PPLC group. Conclusions: The formation of PCO was effectively prevented by performing PPLC; there were no long-term complications in eyes that underwent this short additional intervention.

Purpose: To investigate the feasibility and safety of a new small-aperture device, which is implanted on top of the intraocular lens. Methods: Regular cataract surgery was performed in both eyes in 7 patients. In the non-dominant eye, a small-aperture device (VisionXtender; Morcher) was additionally implanted into the capsular bag at the end of the surgery. The mask had an inner diameter of 1.4 mm. Feasibility and safety were investigated 3 months and 2 years after surgery. Results: In all cases, the device was successfully positioned in the capsular bag without any intraoperative complications. No inflammation was observed at the 3-month follow-up visit. All patients achieved binocular uncorrected distance visual acuity of 0 logarithm of the minimum angle of resolution (log-MAR) or better. Additionally, distance-corrected intermediate visual acuity of 0.1 logMAR or better was measured in the non-dominant eye. Two years postoperatively, Nd:YAG capsulotomy was performed in three patients in both eyes. Conclusions: This clinical feasibility trial demonstrates that the use of the new small-aperture device is both easy and safe. No intraoperative or postoperative complications were reported. All patients attained satisfactory distance, intermediate, and near visual acuity. The device shows significant potential when used in combination with different intraocular lenses (eg, toric). In the future, different opening shapes seem to be possible. [ J Refract Surg . 2024;40(9):e662–e666.]

Background Diabetic retinopathy is a frequent complication of diabetes mellitus and a leading cause of blindness in adults. The objective of this study was to elucidate the diabetic retinopathy pathophysiology in more detail by comparing protein alterations in human vitreous of different diabetic retinopathy stages. Methods Vitreous samples were obtained from 116 patients undergoing pars plana vitrectomy. Quantitative immunoassays were performed of angiogenic factors (VEGF-A, PIGF, Angiopoietin-1, Angiopoietin-2, Galectin-1) as well as cytokines (IL-1β, IL-8, IFN-γ, TNF-α, CCL3) in samples from control patients (patients who don’t suffer from diabetes; n = 58) as well as diabetes mellitus patients without retinopathy (n = 25), non-proliferative diabetic retinopathy (n = 12), and proliferative diabetic retinopathy patients (n = 21). In addition, correlation analysis of protein levels in vitreous samples and fasting glucose values of these patients as well as correlation analyses of protein levels and VEGF-A were performed. Results We detected up-regulated levels of VEGF-A (p = 0.001), PIGF (p<0.001), Angiopoietin-1 (p = 0.005), Angiopoietin-2 (p<0.001), IL-1β (p = 0.012), and IL-8 (p = 0.018) in proliferative diabetic retinopathy samples. Interestingly, we found a strong positive correlation between Angiopoietin-2 and VEGF-A levels as well as a positive correlation between Angiopoietin-1 and VEGF-A. Conclusion This indicated that further angiogenic factors, besides VEGF, but also pro-inflammatory cytokines are involved in disease progression and development of proliferative diabetic retinopathy. In contrast, factors other than angiogenic factors seem to play a crucial role in non-proliferative diabetic retinopathy development. A detailed breakdown of the pathophysiology contributes to future detection and treatment of the disease.

Purpose: In Epi-Bowman Keratectomy™ (EBK), a new dynamic multi-blade single-use device (Epi-Clear™, Orca Surgical, Israel) is utilized to remove the epithelium by sweeping movements across the corneal surface. Epithelial cells are discarded. Alcohol or other chemical agents are not utilized. We wanted to compare clinical results of Epi-Clear photorefractive kertectomy (PRK) to alcohol-assisted PRK. Study design: Retrospective, comparative study. Methods: Consecutive case series: Adult patients seeking laser vision correction of myopia or myopic astigmatism without ocular diseases or prior surgery were included. The Epi-Clear PRK group comprised 50 consecutive eyes of 27 patients and the PRK group 50 eyes of 25 patients. Results: No intraoperative complications occurred. Epi-Clear PRK: At day 1, day 4, and 3 months, uncorrected distance visual acuity (UDVA) was 0.41/0.47/0.93 (decimal scale); epithelial defect diameter was 4.7/0.2/0 (mm); pain level was 3.8/0.3/0 (visual analogue scale, 0–10), respectively. At 3 months, efficacy index was 0.86 and spherical aberrations were unchanged. Three eyes (6%) showed (presumably sterile) infiltrates. PRK: At day 1, day 4, and 3 months, UDVA was 0.56/0.46/1.15; epithelial defect diameter was 6.3/0.2/0 (mm); pain level was 5.0/0.3/0, respectively. At 3 months, efficacy index was 1.1 and spherical aberrations were unchanged. Conclusion: The new method of epithelial debridement with Epi-Clear before laser ablation seems to offer fast epithelial removal without nicking Bowman’s layer (as observed with the laser microscope). However, we found significantly inferior results of Epi-Clear PRK compared to alcohol-assisted PRK. Furthermore, after Epi-Clear PRK corneal infiltrates as a new type of postoperative complication were observed.

Purpose: Excimer laser-based refractive procedures can have less predictable results when used for correcting high myopia than when used for moderate myopia. Small incision lenticule extraction might overcome this weakness. However, small incision lenticule extraction is only Food and Drug Administration approved for use in myopic eyes up to −8 D with astigmatism of −3 D or less. We report outcomes of small incision lenticule extraction in highly and moderately myopic eyes and compare these to modern laser-assisted in situ keratomileusis. Methods: Retrospective, observational consecutive case series. Inclusion criteria: attempted myopic spherical correction ⩾−8 or−3 to −7.75 D with astigmatism ⩽−3 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Results: A total of 62 highly myopic and 407 moderately myopic eyes were included. At 3 months postoperatively, the highly myopic eyes had a mean spherical equivalent refraction of −0.28 ± 0.41 D (range: −1.13 to +0.75 D). Mean uncorrected distance visual acuity was 1.0. Mean efficacy index was 0.84. Mean safety index was 1.03. Uncorrected distance visual acuity same or better than corrected distance visual acuity: 61%. Astigmatism was ⩽0.5 D in 90% and ⩽1 D in 100%. The results in the moderately myopic eyes were comparable. Conclusion: We found equally good visual and refractive outcomes after small incision lenticule extraction for the correction of high and of moderate myopia combined with an astigmatic correction of up to 3 D, respectively.

Purpose: To compare the visual acuity and satisfaction outcomes of 2 different concepts of extended depth-of-focus intraocular lenses (EDOF IOLs). Setting: University Eye Hospital Bochum, Germany. Design: Prospective randomized comparative clinical trial. Methods: Patients undergoing cataract surgery with the implantation of 2 different concept EDOF IOLs. In the first group (IC-8 Group), a monofocal 1-piece Tecnis Z B00 IOL (Johnson & Johnson Vision Care, Inc.) was implanted in the dominant eye, and an IC-8 IOL (AcuFocus) was implanted in the nondominant eye. In the second group (Symfony Group), a Tecnis Symfony IOL (Johnson & Johnson Vision Care, Inc.) was implanted in both eyes. The target refraction of the dominant eye was emmetropia and slight myopia (mini-monovision, −0.75 diopters) in the nondominant eye. Visual and refractive outcomes and patient satisfaction rates were evaluated 3 months postoperatively. Results: This study comprised 76 eyes of 38 patients. No intraoperative or postoperative complications occurred in either group. Target refraction was reached in both groups without statistically significant differences. The uncorrected distance visual acuity (UDVA, photopic and mesopic light conditions) was excellent in both groups with statistically significantly better results in the IC-8 goup (logarithm of the minimum angle of resolution; IC-8 Group (0.1 ± 0.07 logarithm of the minimum angle of resolution [logMAR]; Symfony Group 0.07 ± 0.1 logMAR, P value .02 [photopic]; IC-8 group 0.12 ± 0.09 logMAR, Symfony group 0.22 ± 0.1 logMAR, P value < .01 [mesopic]). Binocular uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) were also good in both groups without statistically significant differences (UIVA: IC-8 Group, 0.01 ± 0.07 logMAR, Symfony Group 0.01 ± 0.08 logMAR, P value .35; UNVA: IC-8 Group 0.14 ± 0.11, Symfony Group 0.09 ± 0.08, P value .14). Subjective satisfaction was high in both groups. Conclusions: Both EDOF IOLs provided a very good UDVA with superior results in the IC-8 Group, and a good UIVA and UNVA under photopic light conditions. Subjective patient satisfaction was higher in the IC-8 Group.

PURPOSE:To determine the long-term safety and effectiveness of a light-adjustable intraocular lens (LAL) over a period that is longer than reported in the literature at the time of the study.SETTING:University Eye Hospital, Bochum, Germany.DESIGN:Noninterventional observation.METHODS:In 445 patients, cataract surgery with LAL implantation was performed between April 2008 and December 2012. It was possible to contact 171 of these patients or their relatives through letter or telephone; 61 patients (103 eyes) agreed to participate in the long-term study and were examined.RESULTS:The mean time between the lock-in (final light treatment) and long-term visit was 7.2 years; 61 patients were included and examined. Corrected and uncorrected distance visual acuity was and remained good (n = 93). The refractive outcome was stable with minimal deviation. There were no significant changes in corneal thickness. In 2 patients, there were slight opacities of the IOL material without impact on visual acuity. Other eye diseases were within the normal range of the patients' age.CONCLUSION:Seven years after implantation and refractive adjustment, eyes with an LAL had stable refraction, good visual acuity, and no IOL-associated pathologies. The findings suggest that LAL technology is a safe and efficient method to achieve good visual results without long-term complications.

A new microinvasive glaucoma surgery device, the Beacon Aqueous Microshunt (BAM), drains aqueous humor directly from the anterior chamber to the surface of the eye vs draining to enclosed spaces within the eye, where outflow resistance, including the episcleral venous pressure, might limit drainage effectiveness. The BAM has a 0.030 mm × 0.048 mm channel and provides a fixed resistance. For implantation, a 1.40 mm wide transcorneal incision into the anterior chamber was created with a posterolimbal outer placement under topical anesthesia. The surgery was easy to execute and had a flat learning curve. Preliminary and early experience have shown success with lowering intraocular pressure immediately postoperatively. In conclusion, the BAM offers a promising minimally invasive surgical procedure.

Purpose: To compare the visual and refractive outcomes of small incision lenticule extraction and advanced surface ablation for low myopia or myopic astigmatism. Methods: Retrospective, observational case series of our first 50 consecutive small incision lenticule extraction patients compared to refraction-matched 50 advanced surface ablation treatments with attempted spherical equivalent correction <=-3.5 D, astigmatism <=-1.5 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Only one eye per patient was included. Results: Small incision lenticule extraction: mean attempted spherical equivalent correction was -2.80 +/- 0.63 D. Uncorrected distance visual acuity was 0.85 and 1.0 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.02 +/- 0.32 D (range: -0.5 to +0.75 D), mean cylinder was -0.24 +/- 0.21 D (range: 0 to -0.75 D), mean uncorrected distance visual acuity was 1.27, mean efficacy index was 0.96, and mean safety index was 1.05. Uncorrected distance visual acuity was same or better than corrected distance visual acuity in 96%, astigmatism <= 0.5 D in 98% and <= 1 D in 100% of eyes, respectively. Advanced surface ablation: mean attempted spherical equivalent correction was -2.75 +/- 0.5 D. Uncorrected distance visual acuity was 0.72 and 0.61 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.22 +/- 0.32 D, mean cylinder was -0.27 +/- 0.27 D, mean uncorrected distance visual acuity was 1.21, mean efficacy index was 1.03, and mean safety index was 1.08. Conclusion: Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes at 3 months similar to those obtained with advanced surface ablation while offering a quicker visual recovery.

Read the full review for this Faculty Opinions recommended article: Precision of bag-in-the-lens intraocular lens power calculation in different age groups of pediatric cataract patients: Report of the Giessen Pediatric Cataract Study Group.

In newborns and young children with cataract, anatomic and physiological abnormalities can be expected. It is of prime importance to understand these special situations and anticipate them when planning a surgical procedure. Every surgeon performing pediatric cataract surgery therefore owes much gratitude to Van Looveren et al.1 for their study of the peculiarities of the vitreolenticular interface, which only can be described as groundbreaking. The Berger space is an anatomic structure or, rather, an anatomic void that has been overlooked or disregarded by generations of ophthalmologists since it was first described in 1887. Our Belgian colleagues have directed our attention to this structure between the posterior capsule and the anterior hyaloid membrane. In children with congenital pathologies such as cataract, it is more than likely that this interface of 2 completely different tissues in the eye might be the site of abnormalities and thus of hurdles for some interventions we might consider. Van Looveren et al.1 have documented the high degree of primary vitreolenticular interface abnormalities in 64 pediatric cases that they encountered when performing cataract surgery. Anterior vitreolenticular interface dysgenesis was found in the majority of patients with unilateral cataract. This poses an enormous obstacle to performing an intervention that is much more necessary in children than in adult cataract patients; that is, a primary posterior capsulotomy, which is widely regarded as an efficient means to stop posterior capsule opacification from developing. Posterior capsule opacification formation is usually swift and strong in children. The described conditions make primary posterior continuous curvilinear capsulorhexis surgically much more demanding, which is reflected in a high rate of breaks in the anterior hyaloid membrane (58.6%) that forced the surgeons in Antwerp to perform anterior vitrectomy in 13.8% of cases. We would like to add our experience with these challenging clinical situations, which is in line with what Van Looveren et al. describe. The single difference is that we use a femtosecond laser (Catalys Precision Laser System, Johnson & Johnson Vision Care, Inc.), which is both a cutting instrument and a diagnostic tool. The 3-dimensional optical coherence tomography of the laser platform gives a clear impression of what anatomic or pathological situation awaits us during the cataract removal (Figure 1). This has proven to be a reliable protection from major unpleasant surprises. In cases of very soft lenses and major dysgenesis, we try to perform a “dry” removal of the lens without irrigation. Once the lens is removed, the laser is used to cut a small hole in the posterior capsule, through which an ophthalmic viscosurgical device can be instilled to push apart the capsule and anterior hyaloid membrane. Next, we perform a primary posterior laser capsulotomy, which we have described in detail.2 The 3-dimensional spectral-domain optical coherence tomography is manually aimed at the posterior capsule (because no software for primary posterior laser capsulotomy has been developed by the manufacturers so far), and the high precision of the laser leads to a perfectly centered, perfectly round capsulotomy. Common parameters for that intervention are 8 μJ energy and an incision depth of 800 μm. When primary intraocular lens implantation is planned, which we prefer for children 1 year or older, we often use the bag-in-the-lens technique introduced by Tassignon et al.3Figure 1: Three-dimensional spectral-domain optical coherence tomography of the anterior segment in a prone patient with insufficiently closed posterior capsule.So far, we have operated on approximately 200 children with pediatric cataracts using the laser for primary posterior laser capsulotomy. The imaging system of this technology makes planning the surgery easier. In cases with severe dysgenesis, as Van Looveren et al.1 have encountered, we can plan ahead to perform an anterior 23-gauge vitrectomy via a paracentesis or the pars plana and thus provide these, our youngest patients, with a good chance for normal development of their eye and its functions.

In the management of glaucoma, recent and upcoming innovations have the potential to contribute to both the efficacy of intraocular pressure (IOP) monitoring and the number of available treatment options. These new devices and procedures have two things in common: they are part of the trend in medicine towards miniaturization, and they require a limited surgical procedure to become effective. This review focuses on the Eyemate (Argos) intraocular sensor, which offers a new way to reliably measure 24 h IOP, and on intraocular sustained release systems for pharmacological glaucoma therapy. It also briefly reflects on the miniature implants currently used in minimally invasive glaucoma surgery (MIGS).

The study by Zhu et al.1 included an impressive number of white cataracts (n = 132) that were removed by femtosecond laser–assisted cataract surgery (FLACS group) or conventional phacoemulsification cataract surgery (CPCS group). The authors correctly point out that advanced cataracts present several challenges for the surgeon. In particular, the increased intracapsular pressure caused by liquefaction of the cortex can render capsulorhexis creation extremely difficult. Having used the femtosecond laser in a series of difficult situations such as pediatric cataract, traumatic cataract, Marfan syndrome, and intumescent white cataract, we find it encouraging to read the results of our Chinese colleagues, most of all the significantly reduced risk for anterior capsule tears when laser capsulotomy is performed rather than continuous curvilinear capsulorhexis. We would like to add our experience with intumescent white cataracts, which we have been treating with FLACS for more than 7 years. The first step to successful surgery in these cases should be taken a few days before the intervention. We consider pretreatment with nonsteroidal antiinflammatory drugs (NSAIDs), 1 eyedrop 3 times on the day of surgery before treatment is initiated, to be very helpful. This minor pharmacologic intervention counteracts the release of the prostaglandin E2 that can be triggered by the femtosecond laser. Local application of NSAIDs has proven to reliably prevent miosis, the last thing a surgeon dealing with a white cataract desires.2 To deal with the intralenticular pressure and prevent the dreaded Argentinian flag syndrome that Zhu et al. encountered in 1 of the 8 eyes that developed anterior tears after conventional phacoemulsification, we highly recommend a 2-step procedure with the laser. Approximately 5 years ago, we introduced a mini-capsulotomy technique in which a smaller capsulotomy (˜2.0 mm diameter) is initially created to release the intralenticular pressure. We then remove the milky liquid that spills out of this small capsulotomy without causing harm to the anterior chamber. The next step is redocking the laser to the patient’s eye and creating a second, larger, regular sized capsulotomy, in general 4.5 to 5.0 mm. All cases we operated on using this 2-step approach had good-quality capsulotomies and 360-degree overlap on the intraocular lens (IOL) optic. Furthermore, this anterior capsulotomy offers optimum conditions to perform anterior optic capture when a posterior capsule tear occurs.3 We recognize, however, that this technique can present problems depending on the clinical setting. In centers in which the laser part of FLACS is performed in a room separate from the operating room (sometimes called a laser suite), this technique is not feasible because it would involve returning the patient to the laser room after fluid removal. Given that the eye is open at this point, such a move would be contraindicated from a microbiological viewpoint. This is another argument for having the femtosecond laser in the operating room.4 Another obstacle for this promising, and in our clinic efficient and safe, technique has been placed by the manufacturers. With at least 1 laser platform (LensX, Alcon), the smallest capsulotomy diameter the system can is perform significantly larger than 2.0 mm. It seems that the industry is not willing, able, or both to integrate a second laser application. This is disapponting because mini-capsulotomy is the way to ensure successful cataract surgery in eyes with white cataract. Another possible problem with high intralenticular pressure is that the anterior capsule can move during or right after the capsulotomy is created; this can lead to uncut regions of the capsulotomy. Uncut areas (our colleagues had 6 eyes with uncut regions in their FLACs group) are something surgeons performing laser capsulotomy should try to avoid because tears can originate from these areas as a result of the rapid outflow of liquid, which in turn can block the ensuing laser shots. Flattening the anterior chamber during the manual part of the surgery can also predispose to anterior capsule tears; it speaks for the experience of the surgeons in the Zhu et al. article that this did not contribute to the documented complications. Where we significantly disagree with our colleagues is the next step the laser usually performs—fragmentation. In the study by Zhu et al., this was done after a creation of a 5.0 mm capsulotomy, which in our experience is far too large for an initial opening. In such a soft, almost liquid lens, fragmentation can be dangerous. The laser does not access the center of the core, and posterior movement of the anterior capsule plane after capsule opening leads to a displacement with subsequent fragmentation of the capsule. Therefore, the fragmentation mode should be deactivated in cases of white cataract. We consider it essential to use staining all cases because visualization is essential during this procedure. It is too late to perform only to detect complications such capsule tears, which would be hard to recognize in an unstained eye because of the lack of a red fundus reflex. We completely agree with Zhu et al. that toric IOLs might be contraindicated in cases of white cataract. That the IOLs were well centered in the FLACS group 1 week postoperatively is good news. Toric IOLs will most likely fail to be a functional and refractive success in these patients because they require exact topographic measurement and evaluation of the cornea preoperatively. However, this is unlikely to take place because these functionally blind eyes are not able to fixate, which is crucial for accurate assessment for toric IOL implantation. We strongly believe that the femtosecond laser offers a technical advantage over conventional cataract surgery and might improve the safety in these high-risk cases by avoiding the perils of manual capsulorhexis that Zhu et al. so impressively documented.

Purpose: To report the outcomes of small-incision lenticule extraction (SMILE) in myopic eyes with astigmatism of 1.0 to 3.0 diopters (D). Setting: Center for Refractive Surgery, Eye Department, St. Francis Hospital, Muenster, Germany. Design: Retrospective case series. Methods: Inclusion criteria were myopia of -0.5 D or more, astigmatism between -1.0 D and 3.0 D, and decimal corrected distance visual acuity (CDVA) of 1.0 or better. Results: The study comprised 206 eyes. Preoperatively, the mean attempted spherical equivalent (SE) correction was -5.45 +/- 2.37 D (range -1.25 to -11.38 D) and the mean cylinder was -1.52 +/- 0.57 D (range -1.0 to -3.0 D). Three months postoperatively, the mean SE refraction was -0.07 +/- 0.38 D (range -1.25 to +1.00 D) and the mean cylinder was -0.32 +/- 0.29 D (range 0.0 to -1.5 D). The mean decimal uncorrected distance visual acuity (UDVA) was 1.13, the mean efficacy index was 0.87, and the mean safety index was 1.00. The UDVA was the same as or better than the CDVA in 67% of cases. The angle of error was +/- 5 degrees in 67% and +/- 15 degrees in 94% of cases, and the residual astigmatism was 0.5 D or less in 88% and 1.0 D or less in all patients. Conclusion: Small-incision lenticule extraction for the correction of myopic astigmatism was safe and effective, with outcomes comparable to those reported for laser in situ keratomileusis using modern eye-tracking systems. (C) 2018 ASCRS and ESCRS