Three-year clinical outcomes and posterior corneal elevation change after small-incision lenticule extraction in suspicious corneas

To determine the long-term clinical outcomes and change in posterior corneal elevation after small-incision lenticule extraction (SMILE) in eyes with suspicious tomographic features.Hospital clinic.Retrospective, case-controlled, observational.This study included 43 patients with suspicious corneas (group A), defined by corneal morphology and a final D score from a Scheimpflug camera (Pentacam), and 43 patients with normal corneal topography (group B). Refraction, visual acuity, and posterior corneal elevation over a 6-mm central diameter, including posterior central elevation (PCE), posterior elevation at the thinnest point (PTE), and posterior maximal elevation (PME), were measured preoperatively and at 6 months, 12 months, and 36 months postoperatively.The preoperative spherical equivalent was -5.51 ± 1.33 D in group A (n = 43) and -5.41 ± 1.19 D in group B (n = 43). Postoperative uncorrected distance visual acuity was 20/20 or better in 39 (91%) of 43 eyes in group A and 41 (95%) of 43 eyes in group B ( P = .160); all eyes in both groups remained stable or had gained corrected distance visual acuity. The mean change in PCE, PTE, and PME at 3 years was -1.22 ± 2.65 μm, -1.21 ± 2.70 μm, and -1.00 ± 5.09 μmin group A and -1.76 ± 3.25 μm, -1.60 ± 3.33 μm, and -1.56 ± 5.01 μm in group B, respectively, indicating a tendency for backward displacement of the posterior surface, whereas the between-group difference was not statistically significant ( P = .154, P = .547, and P = .319, respectively).Refraction, visual outcomes, and posterior corneal shift seem comparable between corneas with normal and suspicious tomographic features three years after SMILE. More long-term studies are warranted to corroborate the findings of this study.