Comparison of objective visual quality between SMILE and FS-LASIK in moderate-to-high myopia.

Purpose: This study aims to compare the changes in the corneal wavefront aberrations and the objective visual quality resulting from two types of eye surgery-small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK)-in patients with moderate-to-high myopia. Methods: A prospective analysis was performed on 98 eyes of 51 patients who underwent SMILE. Additionally, 88 eyes of 45 patients who underwent FS-LASIK were analyzed. All patients underwent ocular examination preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively. Corneal aberrations and objective visual quality were measured using the Optical Quality Analysis System II (OQAS II) and Optical Path Difference Scan III (OPD-Scan III). Results: At postoperative 1 day and 1 week, there was a statistically significant difference in uncorrected distance visual acuity (UDVA) between SMILE and FS-LASIK (P < 0.05). Postoperative spherical (S), cylinder (C) and spherical equivalent refraction (SE) were similar between the two groups (P > 0.05). In both groups, the absolute magnitude of total higher-aberrations (tHOA), piston, vertical tilt, vertical coma, and spherical aberration (SA) increased after surgery compared to preoperative values (P < 0.05). There was no significant difference in Δhorizontal tHOA, Δhorizontal tilt, Δhorizontal coma, and Δhorizontal trefoil between the two groups (P > 0.05), and the FS-LASIK had higher Δvertical trefoil and ΔSA (P < 0.05) but lower Δpiston, Δvertical tilt, and Δvertical coma than the SMILE group (P < 0.05). There was a rise in objective scattering index (OSI) and a decline in both modulation transfer function (MTF) cutoff and Strehl ratio (SR) after surgery compared to preoperative values in both groups (P < 0.05). There was a statistically significant difference in the OSI at 1 day and 3 months between the two groups (P < 0.05). Postoperative MTF cutoff and SR were similar between the two groups (P > 0.05). Postoperative OSI was positively correlated with corneal tHOA (0.261 ≤ R ≤ 0.483, P < 0.05) and was negatively correlated with vertical tilt and vertical coma (-0.315 ≤ R ≤ -0.209, P < 0.05) in both groups. Conclusion: While both SMILE and FS-LASIK can effectively correct moderate-to-high myopia, there is an increase in corneal aberrations and a postoperative delay in objective visual quality. The cornea may require a longer recovery period in the SMILE. OPD-Scan III combined with OQAS II is a useful supplementary inspection for assessing the optical quality following refractive surgery.

Altered Passive Eruption among Patients Visiting Dental Outpatient Department in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: The eruption of teeth is considered to be a continuous phenomenon. Two types of eruption are possible namely, active and passive eruption. Failure in passive eruption (by the apical movement of gingiva from the enamel surface) generally results in a clinical condition known as altered passive eruption. It can result in the shortened crown height of a tooth and an esthetically unpleasant situation i.e., excessive gingival display or gummy smile. The main motto of this study was to find out the prevalence of altered passive eruption and associated gingival biotypes in adult patients visiting for dental treatment in tertiary centers along with strategically placed outreach centers. METHODS: A descriptive cross-sectional study was done in the Department of Dentistry, Dhulikhel Hospital, and four outreach centers of the same hospital. The study was conducted from October 2022 to April 2023 after obtaining the ethical approval. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 165 patients, the prevalence of altered passive eruption was 21 (12.72%) (7.62-17.78 at 95% Confidence Interval). Furthermore, among 21 patients, the altered passive eruption was seen in the thick biotype patients in 16 (76.19%) and thin biotype patients in 5 (23.81%). CONCLUSIONS: The prevalence of altered passive eruption appeared to be equivalent when compared with the previous studies.

Altered Passive Eruption among Patients Visiting Dental Outpatient Department in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: The eruption of teeth is considered to be a continuous phenomenon. Two types of eruption are possible namely, active and passive eruption. Failure in passive eruption (by the apical movement of gingiva from the enamel surface) generally results in a clinical condition known as altered passive eruption. It can result in the shortened crown height of a tooth and an esthetically unpleasant situation i.e., excessive gingival display or gummy smile. The main motto of this study was to find out the prevalence of altered passive eruption and associated gingival biotypes in adult patients visiting for dental treatment in tertiary centers along with strategically placed outreach centers. METHODS: A descriptive cross-sectional study was done in the Department of Dentistry, Dhulikhel Hospital, and four outreach centers of the same hospital. The study was conducted from October 2022 to April 2023 after obtaining the ethical approval. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 165 patients, the prevalence of altered passive eruption was 21 (12.72%) (7.62-17.78 at 95% Confidence Interval). Furthermore, among 21 patients, the altered passive eruption was seen in the thick biotype patients in 16 (76.19%) and thin biotype patients in 5 (23.81%). CONCLUSIONS: The prevalence of altered passive eruption appeared to be equivalent when compared with the previous studies.

Seven-year refractive outcomes comparing small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis for myopia and myopic astigmatism.

This study aimed to compare the seven-year refractive outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of myopia and myopic astigmatism. This retrospective cohort study included 97 eyes of 53 patients who had undergone SMILE or FS-LASIK for myopia seven years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction. There were no significant differences between the SMILE and FS-LASIK groups in logMAR UDVA, cylinder, and logMAR CDVA at 7 years postoperatively (P>0.05). However, there were significant differences between the two groups in sphere and spherical equivalent (P=0.035 and P=0.016, respectively). UDVA was better than or equal to 20/20 in 81% of the eyes after SMILE and in 63% after FS-LASIK (P = 0.045). The efficacy indices of the SMILE and FS-LASIK groups were 1.04 ± 0.23 and 0.97 ± 0.23 (P=0.405), and the safety indices were 1.18 ± 0.19 and 1.10 ± 0.17 (P=0.543), respectively. This study demonstrates the good predictivity of both SMILE and FS-LASIK. SMILE could offer superior refractive outcomes than FS-LASIK during a 7-year follow-up in correcting myopia and myopic astigmatism.

Comparison of visual quality after Q value-guided FS-LASIK and SMILE for correction of myopia with age-related accommodation deficiency.

PURPOSE: To investigate differences in objective and subjective visual quality 12 months following Q value-guided (Custom-Q) femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) versus small incision lenticule extraction (SMILE) for correction of low-to-moderate myopia and compensate for age-related accommodation deficiency. METHODS: Clinical data of 45 patients were analyzed, of whom 23 were treated with FS-LASIK and 22 with SMILE. At the 12-month follow-up, the distance, intermediate, and near visual acuities; objective and subjective refractions; Q factor; corneal higher-order aberrations (HOAs); defocus curve; contrast sensitivity; stereopsis and a subjective visual quality questionnaire were evaluated. RESULTS: At 12 months postoperatively, the two groups had comparable binocular uncorrected distance and intermediate visual acuities (UDVA, UINA). A slightly better uncorrected near visual acuity (UNVA) was observed in the FS-LASIK group (P < 0.05), but patients reported equivalent near vision satisfaction and spectacle independence. Total HOAs and coma increased significantly in all treated eyes (P < 0.05). The Q value and spherical aberration (SA) became more positive, but the shifts were significant only in the SMILE group and the dominant eyes of the FS-LASIK group (P < 0.05). Binocular contrast sensitivity was better in the FS-LASIK group. No significant differences in visual disturbances were found between groups. CONCLUSION: For myopic patients with mild age-related accommodation deficiency, both FS-LASIK with Custom-Q protocol and SMILE could provide good efficacy, safety, predictability, and high patient satisfaction. The Custom-Q protocol could better preserve the original prolate shape of the cornea and achieve superior visual quality compared to SMILE. KEY MESSAGES: What is known Both femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) have been widely applied in young myopic patients, with comparable efficacy and safety. Studies evaluating the clinical outcomes of FS-LASIK and SMILE in treating myopia with age-related accommodation insufficiency are lacking. What is new For myopic patients with mild age-related accommodation deficiency, both FS-LASIK with Custom-Q protocol and SMILE could provide good efficacy, safety, predictability, and high patient satisfaction. The Custom-Q protocol could better preserve the original prolate shape of the cornea and achieve superior visual quality compared to SMILE.

Study of corneal and retinal thicknesses at five years after FS-LASIK and SMILE for myopia.

BACKGROUND: This study aimed to observe corneal and retinal thicknesses at 5 years after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia, investigate the effect of epithelial remodeling on refractive status and visual quality, and compare retinal thicknesses among fundus tessellation grades. METHODS: Patients who received FS-LASIK or SMILE 5 years before were enrolled in this cross-sectional study. After 1:1 propensity score matching, each surgical group obtained 177 patients (177 eyes). Examinations including visual acuity, refraction, corneal and retinal thicknesses, corneal higher-order aberrations (HOAs), and fundus photography were performed in this visit at 5 years after surgery. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms and overall satisfaction. Corneal and retinal thicknesses between groups were compared, contributing factors were analyzed, and correlations with postoperative refractive status, HOAs, QoV scores and overall satisfaction were evaluated. RESULTS: The discrepancy of epithelial thickness between central and pericentral zones in FS-LASIK group was larger than that in SMILE group, which was negatively correlated with postoperative spherical equivalent (SE), positively correlated with spherical aberration (all P < 0.05), but not correlated with QoV scores and overall satisfaction (all P > 0.05) in both surgical groups. There was no statistical difference in stromal thickness and total corneal thickness (all P > 0.05). Most annuluses of epithelial and stromal thicknesse were linearly related to preoperative SE (all P < 0.05). The macular thickness, ganglion cell complex thickness, and retinal nerve fiber layer thickness exhibited comparable values between two surgical groups and four fundus tessellation grades, with no significant association observed with postoperative SE (all P > 0.05). CONCLUSION: The tendency that epithelial thickness in central zone was thicker than peripheral zone was more obvious at 5 years after FS-LASIK compared to SMILE. This uneven distribution of epithelial thickness might play a role in myopic regression and the changes in HOAs, especially in patients with high myopia, but it had little effect on patients' subjective visual quality and satisfaction. Retinal thicknesses were not affected by these two surgical methods, and they did not appear to be the clinical indicators for myopic regression or fundus tessellation progression.

Proteomic analysis reveals key differences in pro-stromal corneal tissue between highly myopic males and females.

Background and purpose: Nowadays, myopia has become a highly prevalent disease globally, especially in East Asia. Epidemiological studies have found that there may be sex differences in the occurrence and progression of myopia, with females having a higher incidence of myopia and higher risk of myopia progression. The purpose of this study was to explore the sex differences in myopic cornea using corneal stroma removed by small incision lenticule extraction (SMILE) surgery. Methods: The corneal stroma of females with high myopia (FH) and males with high myopia (MH) were subjected to proteomic assays. Proteomic-related data were statistically analyzed using software such as MaxQuan, KAAS, Proteome Discovery, etc. The total number of proteins in the cornea and the proteins specifically expressed in the two groups were counted, and the differentially expressed proteins in the two groups were identified by expression fold change >2 and p-value <0.05, and volcano plots were constructed, and functional enrichment analysis, subcellular organelle analysis, and molecular interaction were implemented. Results: Ten samples from each group were analyzed. Twenty-seven proteins were down-regulated and 27 proteins were up-regulated in the FH group, of which 23 proteins were up-regulated in the range of 2-10-fold and 4 proteins were up-regulated in the range of >10-fold. Comparative proteomic analysis of the cornea of male and female patients with high myopia revealed that the expression of corneal extracellular matrix and collagen I, III, V, and VIII-associated proteins were increased in the cornea of female patients, and the transforming growth factor-ß (TGF-ß)/Smad pathway was an important pathway obtained by functional analysis. Conclusion: Comparative proteomic analysis of cornea from male and female patients with high myopia revealed increased expression of proteins related to extracellular matrix and collagen I, III, V, and VIII in female patients, and the TGF-ß/Smad pathway was an important pathway obtained from the functional analysis, suggesting that extracellular matrix remodeling and collagen fiber synthesis may be more active in the cornea of female patients.

Esthetic Crown Lengthening Associated With Modified Lip Repositioning Surgery (Modified LipStat) in the Treatment of Excessive Gingival Display: A 6-Year Follow-Up Case Report.

Smiling expresses emotions and affects interpersonal relationships, influencing self-esteem and social life. Nowadays, concerns about aesthetics and access to the Internet have made people more informed and demanding about treatments for gingival smile. Excessive gingival display (EGD) is caused by a variety of factors that can act alone or in combination. These factors may include altered passive eruption (APE), vertical maxillary excess, a short upper lip, and hyperactive upper lip, among other factors that cause gingival hyperplasia. In this case report, the EGD was caused by vertical maxillary excess, hypermobility of the upper lip, and APE. The proposed treatment included two procedures: the Modified Lip Repositioning Surgery (Modified LipStat) Technique, with internal sutures to attempt to restrict the traction of the upper lip elevator muscles, and Esthetic Crown Lengthening (ECL) from the right first premolar to the left first premolar for the treatment of APE. The result provided an aesthetic improvement of the smile, with harmonization in relation to the size of the teeth. The mobility of the upper lip in spontaneous smiles remained reduced up to 6 months of follow-up; however, there was a partial relapse in the position of the upper lip during spontaneous smiling at the end of 6 years of follow-up.

Recent Advances in Refractive Surgery: An Overview.

Refractive surgery has experienced substantial advancements over the past few years, driven by innovative techniques and continuous technological progress aimed at enhancing visual outcomes and patient satisfaction. Refractive errors such as myopia, hyperopia, and astigmatism affect a significant portion of the global population, impacting quality of life and productivity. Recent advancements have been fueled by a deeper understanding of ocular biomechanics and visual optics, leading to more precise and effective treatments. Traditional methods such as LASIK and PRK have been refined, and new procedures like SMILE (Small Incision Lenticule Extraction) have been introduced, expanding the range of treatable refractive errors and improving safety and predictability. Customized treatments, such as wavefront-guided LASIK and topography-guided PRK, allow for individualized plans tailored to each patient's unique corneal characteristics, enhancing visual acuity and reducing higher-order aberrations. The use of femtosecond lasers in procedures like Femto-LASIK and femtosecond laser-assisted cataract surgery (FLACS) offers unparalleled precision, reducing surgical risks and improving outcomes. Implantable Collamer Lenses (ICLs) and corneal crosslinking (CXL) have emerged as effective options for specific patient groups. Advanced diagnostic tools like optical coherence tomography (OCT) and Scheimpflug imaging have improved surgical planning and complication management. As research and technology continue to evolve, these advancements promise even greater improvements in refractive surgery, addressing the visual needs of the global population.

Effects of facial forms and midline deviations and rolls on female facial beauty according to laypeople, orthodontists, and prosthodontists or restorative dentists.

No study has examined the simultaneous effect of facial forms, midline deviations and midline angulations on facial beauty. Therefore, this comprehensive study aimed to evaluate these and many other hypotheses. This psychometric study was performed on 15,042 observations. A female frontal photograph was edited to 45 perceptometric images with controlled anatomical alteration: 3 facial forms (euryprosopic [brachyfacial], mesoprosopic [mesofacial], leptoprosopic [dolichofacial]), each having either 9 bidirectional midline deviations (0, 1, 2, 3, and 4 mm deviated to the left and right) or 7 bidirectional midline angular deviations (0°, 5°, 10°, and 15° deviated to the left and right). One of the photographs were repeated. These 46 images were esthetically judged by 327 participants (243 laypeople, 49 orthodontists, and 35 'prosthodontists or restorative dentists'). Hierarchical mixed-model multiple linear regressions and post hoc tests were adopted to evaluate the simultaneous impacts of the photomodel's facial forms, midline deviations to the right or left, and midline rolls to the right or left plus sex, age, experience, and dental specialty of the referees on their perception of facial beauty as well as the tolerable zones of midline alterations. These were also done separately for each specialty group, and also for each facial face. Ideal combinations of anatomic features were determined using repeated-measures ANOVAs. Differences between esthetic preferences of different groups in terms of each image were assessed using one-way ANOVAs and t-tests (α = 0.05, α = 0.008, α = 0.001). All 5 anatomical features significantly and independently influenced perception of facial beauty. The tolerance threshold for midline deviations was 1 mm deviations to the right and left sides. For midline rolls, the only tolerable form was the no-roll ('on') midline; the judges preferred right-oriented defects over left-sided ones. The most beautiful facial form was mesoprosopic, followed by leptoprosopic. Men perceived the female face slightly more attractive than did women. The viewers' specialty (or lack of it), their age, or their experience did not affect their esthetic preferences. Predictors of esthetic preferences were all 5 anatomical features plus views' sex, but not their dental specialty, age, or experience. Zones of acceptability and also the ideal range of anatomical features were determined.

Lip repositioning as a complement to gummy smile treatment - A case report.

The aim of this case report was to present an alternative therapeutic combination involving lip repositioning (LR) in the correction of gummy smile (GS). This treatment is less invasive than orthognathic surgery and is highly acceptable to patients, using a modified technique that combines myotomy with the insertion of polyester threads as a physical barrier against relapse.

Clinical and radiographic assessment of gummy smile patients with altered passive eruption: a cross-sectional study in a Thai population.

OBJECTIVES: The study aimed to evaluate the clinical crown length (CCL) among patients diagnosed with altered passive eruption (APE), the causes of a gummy smile, the prevalence of APE, and the correlation between parameters. MATERIALS AND METHODS: A total of 86 gummy smile patients (516 teeth) underwent clinical examination and assessment using cone-beam computed tomography (CBCT), photography, and intraoral scanning. RESULTS: Significantly shorter CCL and distance between the cementoenamel junction and bone crest (CEJ-BC) were observed among APE-affected teeth (p < 0.05). Among the patients, 56.1% of patients were diagnosed with APE, and most of them were affected by a combination of APE and hypermobile upper lip (HUL). Based on 183 APE-affected teeth, the prevalence of APE types and subtypes was as follows: APE1A (96; 19.3%), APE1B (78; 15.9%), APE2A (8; 1.6%), and APE2B (1; 0.2%). Positive correlations were found between keratinized gingival width (KGW) and bone thickness (BT), while negative correlations were observed between gingival thickness (GT) and BT. CONCLUSION: Shorter CCL and CEJ-BC were the highlighted features of APE. APE affected approximately half of the gummy smile patients, with most of them presenting with a combination of HUL. Almost teeth affected by APE were classified as Type I, with a nearly equal distribution between subtypes A and B. CLINICAL RELEVANCE: The clinical and radiographic features of APE contribute to a better understanding of this condition and facilitate the management of patients affected by APE. Approximately half of gummy smile patients will require multidisciplinary treatment.

A More Aesthetically Pleasing Smile: A Case Report on the Impact of Scalpel Technique on Gingival Depigmentation.

Gingival hyperpigmentation can significantly affect how the smile looks cosmetically, leading patients to seek treatment. This case report addresses the use of a scalpel approach combined with bur abrasion for gingival depigmentation in a 19-year-old female patient who was displeased with her "black" gums. A local anesthetic was required for the surgical removal of the pigmented epithelium and a thin layer of connective tissue. Post-operative care included antibiotics and analgesics, with chlorhexidine mouthwash use for optimal healing. Follow-up examinations showed successful depigmentation without complications. This simple method is a good choice for gingival pigmentation management since it provides satisfactory cosmetic results and patient satisfaction.

Comparison of long-term changes in the effective optical zone following SMILE and FS-LASIK for moderate and high myopia.

BACKGROUND: Visual quality after corneal refractive surgery is linked to the postoperative effective optical zone (EOZ). This study aims to compare long-term changes in the EOZ following small incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) for moderate and high myopia. METHODS: This study included 42 patients (72 eyes) who underwent either SMILE (36 eyes) or FS-LASIK (36 eyes). A custom software program based on the tangential curvature difference map of the Pentacam HR (Oculus Optikgeräte GmbH) was used to define the EOZ at 3 and 7 years postoperatively. The EOZ, its chronological changes compared to the programmed optical zone (POZ), and the corneal wavefront aberrations following SMILE and FS-LASIK were analyzed. Correlations between the EOZ changes and relevant parameters were evaluated. RESULTS: Three years postoperatively, EOZ following SMILE and FS-LASIK were 5.13 ± 0.27 mm and 4.70 ± 0.24 mm (P < 0.001), respectively. Seven years postoperatively, EOZ following SMILE and FS-LASIK decreased to 5.03 ± 0.28 mm and 4.63 ± 0.23 mm (P < 0.001), respectively. At postoperative 7 years, the percentages of EOZ/POZ were negatively correlated with Q-value changes (ß = -5.120, P = 0.009) following SMILE and positively correlated with the cylinder correction (ß = 1.184, P = 0.004) following FS-LASIK. The induced spherical aberrations in the SMILE group were less than those in the FS-LASIK group (P < 0.05) and were negatively correlated with the EOZ/POZ (ß = -16.653, P < 0.001). CONCLUSIONS: The EOZ following SMILE was larger than that following FS-LASIK in the long postoperative term for moderate and high myopia. Furthermore, a continual reduction in the EOZ was noted after both surgical modalities.

Nasal natural killer/T-cell lymphoma mimicking orbital cellulitis: A diagnostic dilemma.

Nasal natural killer/T-cell lymphoma (NK/TCL) is a rare form of malignant non-Hodgkin lymphoma (NHL) with a far more rare involvement of orbit. The orbital involvement has a highly variable clinical presentation. Here, we report one such case of a 40-year-old male patient who presented with swelling in the right upper and lower eyelids with the diminution of vision for 12 days. He had a history of blocked nose for two months. Clinical examination and CT scan of the orbit and paranasal sinuses suggested a diagnosis of right orbital cellulitis with pansinusitis. A combination of intravenous antibiotics was started, and functional endoscopic sinus surgery was done. Histopathology was a suggestive of nasal NK/TCLl NHL. After proper staging, the patient was given chemotherapy and radiotherapy. There was a complete resolution of mass with no recurrence over a follow-up of 10 months.

The "Smile Design and Space" Concept for Altering Vertical Dimension of Occlusion and Esthetic Restorative Material Selection.

OBJECTIVE: This article introduces the smile design and space (SDS) concept for managing the vertical dimension of occlusion (VDO) in full-mouth reconstructions and its influence on the selection of esthetic restorative materials. Limitations of traditional VDO adjustment methods are being addressed through a facially driven treatment approach that enhances esthetics improves function and minimizes invasiveness. CLINICAL CONSIDERATIONS: The SDS concept involves detailed evaluations of the incisal edges of the maxillary central incisors in relation to the upper lip at rest and at full smile. This includes analyzing variations in incisal exposure due to differing lip mobility, which can significantly impact gingival esthetics, particularly in cases with gingival exposure during smiling. The concept employs a strategic formula to determine the necessary alterations in VDO based on specific dental relationships and wear patterns. CONCLUSIONS: The SDS concept provides guidelines for full-mouth reconstructions, emphasizing minimal invasiveness and the integration of esthetics with functional dynamics to enhance the predictability of clinical outcomes and reduce complications associated with traditional restoration techniques. CLINICAL SIGNIFICANCE: The SDS concept enhances the precision of full-mouth reconstructions through individualized adjustment of the VDO, tailored to the esthetic and functional requirements of each patient.

The outcomes of first-generation (visumax 500) and second-generation (Visumax 800) keratorefractive lenticule extraction surgeries for astigmatism.

To evaluate the efficiency, predictability, and residual astigmatism between first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries in a prominent astigmatism population. A retrospective cohort study was conducted, and individuals who underwent first- and second-generation KLEx surgeries were enrolled. A total of 31 and 35 eyes were categorized into first and second KLEx groups, respectively. Visual acuity, refraction, topographic parameters, and surgical indices were recorded. Independent t tests were used to compare the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual astigmatism between the two groups. The difference in UDVA was not significant three months after KLEx surgery (P = 0.509), and the SEs three months after surgery also presented similar values between the two groups (P = 0.552). The first KLEx group demonstrated greater residual astigmatism than did the second KLEx group throughout the three-month follow-up period (all P < 0.05). The values of surgically induced astigmatism (SIA), difference vector (DV), magnitude of error (ME) and correction index (CoI) were significantly better in the second KLEx group via vector analysis (all P < 0.05). Old age, high steep keratometry (K), high topographic cylinder, large angle kappa, and a small optic zone were correlated with greater residual astigmatism in the first KLEx group (all P < 0.05), whereas only a small optic zone was significantly correlated with greater residual astigmatism in the second KLEx group (P = 0.047). The second-generation KLEx is correlated with a lower risk of residual astigmatism.

Knowledge, attitudes, and practices toward femtosecond laser small incision lenticule extraction surgery and postoperative care among recipients.

BACKGROUND: To investigate the knowledge, attitudes, and practices (KAP) of individuals who underwent small incision lenticule extraction (SMILE) surgery and explore the influencing factors. METHODS: This cross-sectional study was conducted from June 21, 2023, to August 13, 2023, at Xiangyang Central Hospital. The participants were patients who had undergone SMILE surgery. The self-designed questionnaire had a Cronbach's α = 0.849. Multivariable analyses were performed to determine the factors influencing the KAP scores. RESULTS: Finally, 485 valid questionnaires were analyzed. The median knowledge score was 14 (/17, 82.4%; IQR: 12-15). The median attitude score was 15 (/20, 75.0%; IQR: 14-16). The median practice score was 48 (/60, 80.0%; IQR: 42-54). The knowledge scores correlated to the attitude (r = 0.323, P < 0.001) and practice (r = 0.202, P < 0.001) scores, while the attitude scores correlated to the practice scores (r = 0.065, P < 0.001). College diploma (OR = 0.299, 95%CI: 0.110-0.812, P = 0.018), myopia for < 2 years (OR = 0.177, 95%CI: 0.060-0.526), and not receiving proper eye training (OR = 0.588, 95%CI: 0.402-0.862) were independently associated with knowledge. Being 19-30 years old (OR = 0.421, 95%CI: 0.235-0.756), being ≥ 31 years old (OR = 0.259, 95%CI: 0.111-0.601), myopia for 2-5 years (OR = 0.476, 95%CI: 0.232-0.978), myopia for 5-10 years (OR = 0.480, 95%CI: 0.263-0.875), and moderate myopia in the right eye (OR = 1.745, 95%CI: 1.024-2.974) were independently associated with attitude. Female gender (OR = 1.826, 95%CI: 1.196-2.787), being ≥ 31 years (OR = 2.587, 95%CI: 1.113-6.014), college diploma (OR = 3.436, 95%CI: 1.366-8.641), bachelor's degree (OR = 2.826, 95%CI: 1.214-6.581), and not having proper eye training (OR = 0.458, 95%CI: 0.310-0.677) were independently associated with practice. CONCLUSIONS: Patients who underwent SMILE had high KAP regarding SMILE. This study identified KAP items that would warrant education.

O uso da proteína botulínica na correção do sorriso gengival / The use of botulinum protein in the correction of gingival smile

A sociedade está cada vez mais exigente e em busca de excelência quando o assunto é estética facial. O sorriso tem grande impacto na harmonia da face e, atualmente, os pacientes estão mais conscientes sobre a influência da gengiva na beleza do sorriso. A exposição da gengiva em excesso, conhecida como sorriso gengival, afeta a estética, podendo interferir na autoestima e nas relações sociais dos pacientes. Existem diversos procedimentos descritos para solucionar o problema e, para o planejamento do caso e escolha do método, é preciso determinar a etiologia e levar em consideração o desejo do paciente. A injeção da proteína botulínica é uma alternativa minimamente invasiva que está sedo cada vez mais utilizada para a correção do sorriso gengival. Com isso, o objetivo do presente trabalho monográfico foi realizar uma revisão de literatura sobre o uso da toxina botulínica na correção do sorriso gengival, analisando técnicas de injeção, identificando o efeito imediato e a longo prazo da toxina nos músculos elevadores do lábio superior, além de avaliar a relevância desse método na correção do sorriso gengival, sozinho ou em conjunto com outros procedimentos. Foi realizada uma revisão de literatura nas bases de dados PubMed e Scielo, buscando artigos dos anos de 2013 até 2022, utilizando os descritores "botulinum toxin", "botox", "gummy smile", "gingival display" e "gingival exposure". Essa revisão analisa 15 artigos que discorrem sobre o método, durabilidade e eficácia da aplicação de proteína botulínica para correção do sorriso gengival. Algumas variantes diferenciam as técnicas de aplicação, como a marca do produto e recomendações do fabricante, classificação do sorriso e extensão da exposição gengival. Com base na revisão de literatura, pôde-se concluir que, apesar de ser transitório, esse procedimento se mostrou eficaz, tanto ao ser realizado como método principal, quanto como coadjuvante no tratamento. Além de ser comprovadamente seguro, rápido, minimamente invasivo e ser o tratamento de preferência entre os pacientes, com alto índice de satisfação, são raras as complicações relacionadas a aplicação da proteína botulínica para esse fim.

Society is becoming increasingly demanding, seeking excellence in facial aesthetics. The smile greatly impacts facial harmony, and nowadays, patients are more aware of the influence of the gums on smile beauty. Excessive gum exposure, known as gummy smile, affects aesthetics and can interfere with patients' self-esteem and social relationships. There are various procedures described to address this issue, and for case planning and method selection, it is necessary to determine the etiology and take into account the patient's desires. The injection of botulinum protein is a minimally invasive alternative that is increasingly being used for gummy smile correction. Thus, the aim of this monographic work was to conduct a literature review on the use of botulinum toxin in gummy smile correction, analyzing injection techniques, identifying the immediate and long-term effects of the toxin on the upper lip elevator muscles, and evaluating the relevance of this method in gummy smile correction, either alone or in conjunction with other procedures. A literature review was conducted in the PubMed and Scielo databases, seeking articles from 2013 to 2022, using the descriptors "botulinum toxin", "botox", "gummy smile", "gingival display", and "gingival exposure". This review analyzes 15 articles that discuss the method, durability, and effectiveness of botulinum toxin application for gummy smile correction. Some variations differentiate the application techniques, such as the product brand and manufacturer's recommendations, smile classification, and extent of gum exposure. Based on the literature review, it was possible to conclude that, despite being temporary, this procedure proved to be effective, both when performed as the main method and as an adjunct in treatment. In addition to being proven safe, fast, minimally invasive, and the preferred treatment among patients, with a high satisfaction rate, complications related to botulinum toxin application for this purpose are rare.

Dose and injection site of botulinum toxin type A for gummy smile management: A systematic review and bibliometric analysis.

INTRODUCTION: Botulinum toxin type A (BoNT/A) is an effective non-surgical method for treating gummy smile (GS). This systematic review evaluated the efficacy, duration, and safety of different BoNT/A injections. METHODS: Four electronic databases were searched for relevant literature, generating 1106 references. RESULTS: The review included 13 prospective, controlled clinical trials. The mean pre-injection anterior gingival exposure ranged from 3.5 mm to 6.8 mm, reaching maximum effect at 2-4 weeks post-injection. Most studies indicated complete improvement in gingival exposure post-injection, with gingival exposure reduced to ≤3 mm. The dosage of BoNT/A was determined by the severity of gingival exposure, with effects lasting up to 12-24 weeks. Levator labii superioris alaeque nasi (LLSAN), levator labii superioris (LLS), and zygomaticus minor (ZMi) were the main targeted muscles. Next, bibliometric analysis was conducted to provide an overview of the existing publications on managing gummy smiles. CONCLUSIONS: This data demonstrates that BoNT/A can effectively treat various types of GS triggered by muscle hyperactivity. It is a non-intrusive treatment with significant improvement, high safety, minimal side effects, and high patient satisfaction. This study was preregistered in the Prospective Register of Systematic Reviews (CRD42024509183). CLINICAL SIGNIFICANCE: This study systematically reviewed and compared previous results on efficacy, duration, patient satisfaction, and adverse effects of different botulinum toxin type A doses and injection sites, laying a solid foundation for further studies that use BoNT/A in the management of gummy smiles.