Dexamethasone (dex)

All donor tissues were collected from the eye bank of the Hainan Eye Hospital in accordance with local guidelines (Hainan Entry-Exit Inspection and Quarantine Bureau of the People's Republic of China). Topical anaesthesia consisted of proparacaine hydrochloride eye drops (Alcaine; Alcon Laboratories, Fort Worth, TX). A myopic correction of −0.75 diopters (28 μm thickness) using a femtosecond laser system under SMILE treatment was performed on the recipient cornea, and the surgical incision was 2.5 mm long. The surgeon unfolded the lenticule with microforceps and created a “stromal pocket” at a depth of 160 μm from the cornea epithelium, followed by implantation of the lenticule into the “stromal pocket.” The surgical procedures were detailed in our previous studies [13 (link), 16 (link)]. Following the surgery, all patients received tobramycin and dexamethasone (Alcon Laboratories, US) eye drops 4 times per day for 2 weeks and recombinant bovine basic fibroblast growth factor (Fusion Protein, Bausch and Lomb, Rochester, NY) eye gel 3 times per day for 6 months.

All patients underwent uncomplicated cataract surgery by two experienced cataract surgeons (Y.Z.L. and W.R.C.). General anesthesia was administered prior to surgery. After a temporal clear corneal incision was made, DuoVisc and a soft-shell technique were used to reform and stabilize the anterior chamber and protect the corneal endothelium. A 5.5–6.0 mm central continuous curvilinear capsulorhexis was created using a bent 26-gauge disposable needle. Hydro-dissection was performed using a balanced salt solution, and a standard phacoemulsification was performed to completely remove the lens. A 3-piece monofocal acrylic IOL with a 6.5-mm optic diameter (Sensar AR40e, AMO, Inc. CA, USA) was placed via in-the-bag implantation following lens removal.
Postoperative topical therapy included the administration of 0.3 % tobramycin and 0.1 % dexamethasone eye drops (Tobradex, Alcon Laboratories, Inc, Texas, USA) four times per day and 0.3 % tobramycin and 0.1 % dexamethasone eye ointment (Tobradex, Alcon Laboratories, Inc, Texas, USA) every night for 1 month.

Tobradex (tobramycin 0.3% and dexamethasone 0.1%, Alcon, FortWorth, TX, USA) eyedrop was administered 4 times per day, followed by a weekly taper for 4 weeks thereafter, before shifting to 0.1% fluorometholone eye drops (Allergan, County Mayo, Ireland) 4 times per day followed by a weekly taper for 4 weeks. Preservative-free lubricants were used 4 times per day for 1 month. All patients were followed up daily for 1 week, weekly for 1 month, monthly for 3 months, and then at different intervals after surgery.

Twelve rhesus monkeys were anaesthetized using an intramuscular injection of Zoletil 50 (5 mg/kg, Virbac). They then underwent SMILE surgery in one randomly selected eye to achieve a myopic treatment correction of −0.75 D. The following femtosecond laser parameters were used: 135 nJ, 160-μm cap thickness, 7.8-mm cap diameter, and 7.8-mm lamellar cornea diameter. A small incision was made at the 140° position with a side cut angle of 90°. The lenticule (28-μm thickness) was separated, and a space similar to a “stromal pocket” was produced (Fig. 2a). The graft was implanted in the “stromal pocket” (Fig. 2b). We avoided inverting the surface of the graft during implantation.Fig. 2

The procedure of implantation. a With SMILE surgery assisted, spread the lenticule out, producing a space like a ‘stromal pocket’. b Use forceps to implant the graft to the ‘stromal pocket’

Following the surgery, all monkeys received tobramycin and dexamethasone (Alcon Laboratories, US) eye drops 4 times per day for 1 week. We observed the ocular appearance of the monkeys every day and examined the 12 monkeys that received grafts at 1 week after implantation and 1, 3 and 6 months thereafter.

All cataract surgeries were performed using the phacoemulsification technique and the insertion of a foldable hydrophilic acrylic intraocular lens (AcrySof IQ IOL, Alcon, Inc.) in the capsular bag. A total of 0.3 mg TobraDex ointment (tobramycin 0.3% and dexamethasone 0.1%, Alcon, Inc.) was used at the end of the surgery in all patients. All patients were instructed to administer TobraDex eye drops (tobramycin 0.3% and dexamethasone 0.1%, Alcon, Inc.) 4 times daily for 2 weeks after surgery and 2 times daily until 4 weeks after cataract surgery. In addition, all patients were instructed to administer 0.1% Diclofenac sodium eye drops 4 times daily for 4 weeks after surgery. All patients were followed for at least 4 weeks after surgery.