Evaluation of the Effects of Myopic Astigmatism Correction and Anterior Corneal Curvature on Functional Optical Zone After SMILE

Purpose: To evaluate the influence of different degrees of myopic astigmatism correction and preoperative anterior corneal curvature on the functional optical zone (FOZ) following small incision lenticule extraction (SMILE). Methods: In this retrospective study, 68 patients (106 eyes) treated with SMILE were grouped according to myopic astigmatism correction: control (0.00 diopters [D]), moderate astigmatism (−0.50 to −2.00 D), and high astigmatism (> −2.00 D). The FOZ was measured and compared between the three groups for 3 months. Correlations between attempted correction, anterior corneal curvature, corneal aberrations, and the FOZ were analyzed. Results: The preoperative mean treatment spherical equivalent was comparable among the three groups. The average FOZ was 5.06 ± 0.24 mm in the control group, 5.19 ± 0.25 mm in the moderate astigmatism group, and 5.35 ± 0.20 mm in the high astigmatism group The FOZ showed statistically significant differences among the three groups ( P < .001), particularly between the high astigmatism group and the other two groups ( P < .001 and .018). Correlation analysis showed that the total higher order aberrations, coma, and spherical aberration change were correlated with the FOZ ( P < .001). Preoperative steep keratometry, average keratometry, and corneal astigmatism were significantly correlated with the FOZ ( P < .05). The correlation remained after excluding the influence of attempted correction on the FOZ ( P < .05). After adjusting for other risk factors using multiple linear regression analysis, there was still a significant positive association between preoperative steep keratometry and the FOZ ( P < .001). Conclusions: Patients with higher myopic astigmatism achieved a larger FOZ and less induced horizontal coma than the control and moderate astigmatism groups. A larger FOZ after SMILE can be achieved in eyes with steeper keratometry. [ J Refract Surg . 2023;39(2):135–141.]