{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:02:21Z","timestamp":1789988541145,"version":"4.0.1"},"reference-count":18,"publisher":"SLACK, Inc.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Refract Surg"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>PURPOSE:<\/jats:title><jats:p>To report the development of an opaque bubble layer (OBL) during small incision lenticule extraction (SMILE) and analyze its potential risk factors and the clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>A retrospective review of medical records was performed. The patients were divided into two groups in terms of OBL area following a posterior lenticule cut: OBL less than 5% of cornea and OBL greater than 5% of cornea. Preoperative parameters and clinical outcomes were compared. The association between amount of OBL and the various parameters was determined using a correlation analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>The study included 208 myopic eyes (106 patients). The incidence of OBL was 51.82% (108 eyes) and mean OBL area was 3.06% \u00b1 4.62%. The OBL greater than 5% group (48 eyes, 23.08%) had a thicker cornea, a thinner lenticule, and a longer operation time than the OBL less than 5% group (160 eyes, 72.92%). Visual acuity, efficacy, and safety were similar between groups except for a slightly lower predictability value for the OBL greater than 5% group. The amount of OBL area presented a quantitative association with corneal thickness, lenticule thickness, and the relative vertical position of the posterior lenticular surface. Flap tear was observed in 8 eyes (3.84%), at which an extensive amount of OBL (9.76% \u00b1 7.02%) developed.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Eyes with a thicker cornea or a thinner lenticule are more likely to develop OBL during SMILE. The OBL does not affect the overall clinical outcome. In eyes with extensive OBL, there is a higher incidence of flap tear and a lower predictability value.<\/jats:p><jats:p><jats:bold>[<jats:italic>J Refract Surg.<\/jats:italic>2017;33(1):24\u201329.]<\/jats:bold><\/jats:p><\/jats:sec>","DOI":"10.3928\/1081597x-20161006-06","type":"journal-article","created":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T20:10:38Z","timestamp":1483992638000},"page":"24-29","source":"Crossref","is-referenced-by-count":35,"title":["Possible Risk Factors and Clinical Effects of Opaque Bubble Layer in Small Incision Lenticule Extraction (SMILE)"],"prefix":"10.3928","volume":"33","author":[{"given":"Gisung","family":"Son","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junghyun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheolwon","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Yong","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beom Jin","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae Hyung","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2308","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00055735-200208000-00011"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.08.013"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1109\/2944.796309"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2007.10.026"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.08.055"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20150820-06"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2014.10.039"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2009.174284"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20140120-04"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-013-2400-x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.07.056"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070208"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2010.07.033"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20140320-03"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S43723"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","first-page":"S85","DOI":"10.3928\/1081597X-20080101-15","article-title":"Depth-dependent cohesive tensile strength in human donor corneas: implications for refractive surgery","volume":"24","author":"Randleman JB","year":"2008","unstructured":"Randleman JB, Dawson DG, Grossniklaus HE, McCarey BE, Edelhauser HF. 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