{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:24:10Z","timestamp":1787775850002,"version":"build-2784847793"},"reference-count":57,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,9,10]],"date-time":"2018-09-10T00:00:00Z","timestamp":1536537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Corneal refractive surgery disrupts corneal integrity and reduces biomechanical stability in consequence of the beneficial refractive alteration. The minimal invasive cap\u2010based refractive procedure, small\u2010incision lenticule extraction (SMILE), has been proposed to affect corneal integrity less than flap\u2010based procedures, due to the fibre\u2010sparing incision of the strong anterior corneal lamellae. Flap\u2010based procedures include laser\u2010assisted in\u00a0situ keratomileusis (LASIK), femtosecond laser\u2010assisted in\u00a0situ keratomileusis (FS\u2010LASIK) and femtosecond lenticule extraction (FLEx). The purpose of this systematic review was to evaluate corneal biomechanical changes by noncontact air pulse tonometry after treatment of myopia\/myopic astigmatism with SMILE compared to flap\u2010based refractive surgery. A total of 220 publications were identified through a systematic search in PubMed and Embase. Two levels of screening identified nine studies (three randomised controlled trials (RCT) and six nonrandomised clinical trials) eligible for the review. All the nonrandomised clinical trials were graded to have an overall serious risk of bias. Measurements with the Corvis ST were not included in any of the eligible studies. The RCTs found no statistical significant differences between SMILE or flap\u2010based procedures concerning corneal hysteresis (CH) or corneal resistance factor (CRF), as measured with the Ocular Response Analyzer. However, a greater reduction in CRF and CH was found in the flap\u2010based group in five and two of the nonrandomised studies, respectively. The findings in this review illustrate that the presumed biomechanical advantages of a cap\u2010based small incision could not be demonstrated in existing studies and by commercially available technology. However, studies with lower levels of evidence suggest less affection of corneal viscoelastic properties after SMILE when evaluating corneal stability by noncontact tonometry.<\/jats:p>","DOI":"10.1111\/aos.13906","type":"journal-article","created":{"date-parts":[[2018,9,11]],"date-time":"2018-09-11T06:23:06Z","timestamp":1536646986000},"page":"127-136","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Comparison of corneal biomechanical changes after refractive surgery by noncontact tonometry: small\u2010incision lenticule extraction versus flap\u2010based refractive surgery \u2013 a systematic review"],"prefix":"10.1111","volume":"97","author":[{"given":"Pernille","family":"R\u00e6vdal","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Odense University Hospital Odense Denmark"},{"name":"Research Unit of Ophthalmology University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5019-0736","authenticated-orcid":false,"given":"Jakob","family":"Grauslund","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Odense University Hospital Odense Denmark"},{"name":"Research Unit of Ophthalmology University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1687-4899","authenticated-orcid":false,"given":"Anders H\u00f8jslet","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Odense University Hospital Odense Denmark"},{"name":"Research Unit of Ophthalmology University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,10]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2013.05.003"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/IIO.0b013e31820f1d2d"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20100218-04"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.13035"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.17-23675"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000556"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000571"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081-597X-20070101-12"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICL.0000000000000280"},{"key":"e_1_2_5_11_1","unstructured":"HigginsJPT&GreenS. (2011).Cochrane Handbook for Systematic Review of Interventions version 5.1. Chapter 8: Assessing risk of bias in included studies [Online]. Cochrane Statistical Methods Group and the Cochrane Bias Methods Group The Cochrane Collaboration. Available at:http:\/\/handbook-5-1.cochrane.org\/(Accessed 19 Dec 2017)."},{"key":"e_1_2_5_12_1","unstructured":"HowickJ PhillipsB BallC SackettD BadenochD StrausS HaynesB&DawesM. (2009).Oxford Centre for Evidence\u2010based Medicine \u2013 Levels of Evidence [Online]. Centre for Evidence\u2010based Medicine Oxford. Available at:http:\/\/www.cebm.net\/blog\/2009\/06\/11\/oxford-centre-evidence-based-medicine-levels-evidence-march-2009\/(Accessed 19 Dec 2017)."},{"key":"e_1_2_5_13_1","first-page":"340","article-title":"LASIK \u2010 A corneal evaluation through biomechanics","volume":"51","author":"Ivana OT","year":"2016","journal-title":"Archiv Balkan Med Union"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e3181967082"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000230670"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.12.013"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2008.05.026"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0420.2007.01023.x"},{"key":"e_1_2_5_19_1","first-page":"2244","article-title":"The three\u2010dimensional organization of collagen fibrils in the human cornea and sclera","volume":"32","author":"Komai Y","year":"1991","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.16-19615"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2004.10.044"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0925-4439(92)90041-K"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/290619"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.85.4.437"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.1900100511"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1991.01080120083031"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2006.09.036"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.05.041"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.icu.0000233963.26628.f0"},{"key":"e_1_2_5_31_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20080101-15"},{"key":"e_1_2_5_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2007.03.073"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20130617-03"},{"key":"e_1_2_5_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.08.065"},{"key":"e_1_2_5_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.11.030"},{"key":"e_1_2_5_36_1","doi-asserted-by":"publisher","DOI":"10.3109\/02713683.2015.1082185"},{"key":"e_1_2_5_37_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081-597X-19980501-15"},{"key":"e_1_2_5_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2008.05.033"},{"key":"e_1_2_5_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2009.174284"},{"key":"e_1_2_5_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2009.02.005"},{"key":"e_1_2_5_41_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.16-20211"},{"key":"e_1_2_5_42_1","unstructured":"SterneJAC Hern\u00e1nMA ReevesBCet\u00a0al. (2016).The Risk Of Bias In Non\u2010randomized Studies \u2013 of Interventions (ROBINS\u2010I) assessment tool [Online]. Available at:https:\/\/53e94a67-a-62cb3a1a-s-sites.googlegroups.com\/site\/riskofbiastool\/ROBINS-I%20tool%20template%201aug2016.pdf?attachauth=ANoY7cr3CAGDOyyv2JLlPWAu7VGwR6wTepnYuwYiZbQKPI6YZdgm1WzwjDDzsLU1mErb1oVQDKZ6OUa6WdgXYv9h6pVwtjbogaLKqpz9FIy4zPftfiw32tYS2FdlmEiUMWUvJtrqufFjDb6HoJD_izsBzIEvT_DOgEoCVOGd5StVfAv35H63LqCgU6JNUm0DPL1wr1eK3WyPXdtMI0s8QtFo5&g-TiIz8pM9dk8ca_yaxHxDq6pqFMTLgpoxEuLquE-UGc5EjM6&mU&attredirects=0(Accessed 19 Dec 2017)."},{"key":"e_1_2_5_43_1","doi-asserted-by":"publisher","DOI":"10.3109\/02713683.2012.669007"},{"key":"e_1_2_5_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.10.044"},{"key":"e_1_2_5_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/cxo.12211"},{"key":"e_1_2_5_46_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20140120-05"},{"key":"e_1_2_5_47_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20140903-09"},{"key":"e_1_2_5_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2016.01.007"},{"key":"e_1_2_5_49_1","first-page":"115","article-title":"Small\u2010incision lenticule extraction versus femtosecond lenticule extraction for myopic: a systematic review and Meta\u2010analysis","volume":"10","author":"Wang JS","year":"2017","journal-title":"Int J Ophthalmol"},{"key":"e_1_2_5_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2017.03.013"},{"key":"e_1_2_5_51_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/758196"},{"key":"e_1_2_5_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.07.056"},{"key":"e_1_2_5_53_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2016-308636"},{"key":"e_1_2_5_54_1","doi-asserted-by":"publisher","DOI":"10.3109\/02713683.2015.1107590"},{"key":"e_1_2_5_55_1","first-page":"1436","article-title":"Clinical outcomes of small incision lenticule extraction versus femtosecond laser\u2010assisted LASIK for myopia: a Meta\u2010analysis","volume":"10","author":"Yan H","year":"2017","journal-title":"Int J Ophthalmol"},{"key":"e_1_2_5_56_1","doi-asserted-by":"publisher","DOI":"10.4274\/tjo.49260"},{"key":"e_1_2_5_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.12396"},{"key":"e_1_2_5_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joco.2016.08.004"}],"container-title":["Acta Ophthalmologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Faos.13906","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.13906","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aos.13906","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.13906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T13:56:31Z","timestamp":1694008591000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aos.13906"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,10]]},"references-count":57,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1111\/aos.13906"],"URL":"https:\/\/doi.org\/10.1111\/aos.13906","archive":["Portico"],"relation":{},"ISSN":["1755-375X","1755-3768"],"issn-type":[{"value":"1755-375X","type":"print"},{"value":"1755-3768","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,10]]},"assertion":[{"value":"2018-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}