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Background
Different enhancement procedures have been suggested for reduction of residual refractive errors after SMILE. The aim of this study is to evaluate an improved cap-preserving technique for enhancement after SMILE (Re-SMILE). MethodsA retrospective case series was conducted at Eye subspecialty center, Cairo, Egypt on 9 eyes with myopia or...
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Background:
Some studies have shown that there is a certain rotation of the eye in the sitting and lying position of the patient. The Visumax system used for the Refractive Lenticule Extraction-Small Incision Lenticule Extraction (ReLEx SMILE) surgery lacks the rotation of eye control function. So, is the ReLEx SMILE surgery for patients with asti...
Citations
... [25] This method maintains the flap-free advantage of SMILE. Although an effective option for retreatment using a custom-made centering marker, [26] the procedure is difficult, especially in cases of low residual errors. Additionally, the outcomes and safety of the procedure have not yet proven to be equivalent to the already available enhancement options. ...
Purpose:
To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK).
Methods:
Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software.
Results:
In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04).
Conclusion:
PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.
... 5 In these cases, the most common enhancement procedures are photorefractive keratectomy (PRK) and LASIK, 6,7 though there are some reports of repeat SMILE. 8 This retrospective, single-site review seeks to determine rates of enhancement and visual prognosis following PRK enhancement of SMILE. ...
... Between the first published trials of SMILE in 2011 and June 2022, 9 we identified twelve studies in the literature that present cases of enhancement following SMILE (Table 3). 5,8,[10][11][12][13][14][15][16][17][18] Of these, eight identified rates of enhancement following SMILE. In a 2017 study in Singapore, Liu et al found a prevalence, 1-year incidence, and 2-year incidence of enhancement of 2.7%, 2.1%, and 2.9%, respectively. ...
... One of the Re-SMILE studies is a single case report, 18 and the other was a series of nine cases. 8 DovePress these, a 2014 study by Ivarsen et al, involved therapeutic enhancement following five cases of SMILE complicated by post-operative irregular astigmatism. 10 Considering this complication, visual outcomes are poorer than in the other studies and may not be representative of a typical enhancement. ...
Purpose:
To determine rates of enhancement and visual prognosis following photorefractive keratectomy (PRK) enhancement of small-incision lenticule extraction (SMILE).
Patients and methods:
This retrospective, single-site study reviewed all cases of primary SMILE at Hoopes Vision in Draper, Utah between March 14, 2017 and April 8, 2022 to identify any cases that required follow-up enhancement. Primary SMILE was performed using Visumax 500 kHz femtosecond laser (Carl Zeiss Meditec, Jena, Germany). All enhancements were performed with alcohol-assisted PRK, using a WaveLight EX500 excimer laser (Alcon Laboratories, Inc., Fort Worth, TX).
Results:
Four hundred and five eyes underwent primary SMILE, of which 15 later underwent PRK enhancement (enhancement rate of 3.7%). No significant difference in pre-SMILE data was identified between the enhancement and non-enhancement groups. The average age of those who underwent PRK enhancement was 33.8±6.3 years old and ranged from 25 to 45. Following primary SMILE, 13 eyes (87%) had an uncorrected distance visual acuity (UDVA) of 20/40 or better, and none had a UDVA of 20/20 or better. After one year of post-enhancement follow-up, all eyes had a UDVA of 20/40 or better, and 13 eyes (87%) had a UDVA of 20/20 or better (Figure 1). All were within one diopter of target spherical equivalent (SEQ), 13 (87%) were within 0.50 D, and 10 (67%) were within 0.25 D. Of those with 12-month follow-up data, none had UDVA worse than corrected distance visual acuity (CDVA), and none had lost lines of CDVA. Efficacy and safety indices were 1.03 and 0.99, respectively.
Conclusion:
Following SMILE, ophthalmologists may anticipate an enhancement rate of one to seven percent. In these cases, PRK is a safe and effective procedure for enhancement of SMILE.
... There are many alternatives to choose to correct post-SMILE residual refractive errors or post-SMILE myopic regression [8]. Photorefractive keratectomy (PRK) benefits from not making a corneal flap and preserving corneal stromal tissue, and thus avoids the potential risk of postoperative keratectasia [9]. ...
Abstract Background To evaluate predictability, stability, efficacy, and safety of transepithelial photorefractive keratectomy (TPRK) using smart pulse technology (SPT) (SmartSurface procedure) of Schwind Amaris with mitomycin C for correction of post small incision lenticule extraction (SMILE) myopic residual refractive errors. Method This study is a prospective, non-comparative case series conducted at a private eye centre in Ismailia, Egypt, on eyes with post-SMILE myopic residual refractive errors because of undercorrection or suction loss (suction loss occurred after the posterior lenticular cut and the creation of side-cuts; redocking was attempted, and the treatment was completed in the same session with the same parameters) with myopia or myopic astigmatism. The patients were followed up post-SMILE for six months before the SmartSurface procedure, and then they were followed up for one year after that. TPRK were performed using Amaris excimer laser at 500 kHz. The main outcomes included refractive predictability, stability, efficacy, safety and any reported complications. Results This study included 68 eyes of 40 patients out of 1920 total eyes (3.5%) with post-SMILE technique myopic residual refractive errors. The average duration between the SMILE surgery and TPRK was 6.7 ± 0.4 months (range 6 to 8 months). The mean refractive spherical equivalent (SE) was within ± 0.50 D of plano correction in 100% of the eyes at 12 months post-TPRK. Astigmatism of
... [1][2][3][4] Secondary SMILE as a retreatment approach after primary SMILE (re-SMILE) has also been reported. [5][6][7] However, to the best of our knowledge, up till now there is no report of SMILE as an enhancement treatment for other corneal refractive techniques, such as photorefractive keratectomy (PRK). Herein, we report a 4-year follow-up of SMILE retreatment in a patient with high residual refractive error 12 years after PRK. ...
... [6] Afterward, Sedky et al. showed the effectiveness of cap-preserving re-SMILE in reducing residual refractive errors after primary SMILE in a small case series of high myopic patients. [7] Residual refractive error is a known complication after LASIK and PRK leading to decrease of UDVA in patients following these procedures. Various enhancement techniques have been described for the correction of residual refractive error after LASIK and PRK. ...
A 36-year-old male underwent uneventful small incision lenticule extraction (SMILE) for the correction of his high residual refractive error 12 years after photorefractive keratectomy (PRK). Preoperatively, uncorrected distance visual acuity (UDVA) was counting fingers in both eyes. Corrected distance visual acuity was 20/20 in the right and 20/30 in the left eye due to amblyopia. One month after SMILE, UDVA was 20/20 and 20/30 in the right and left eye, respectively; post-PRK corneal haze had reduced. During the 4-year follow-up, UDVA remained stable and there were no complications. SMILE could be a good alternative approach for retreatment in post-PRK patient.
... To achieve correct centration alignment of both treatments, the use of a custom SMILE retreatment centering marker has been described. 9 Moreover, the diameter of the treatment zone was found to be optimal if being programmed 0.2 mm less than the original diameter to facilitate lenticule dissection. 9 Nevertheless, enhancement using reSMILE is currently off-label and considered as cumbersome by most surgeons, and has not yet been proven to be equivalent to alternative established options. ...
... 9 Moreover, the diameter of the treatment zone was found to be optimal if being programmed 0.2 mm less than the original diameter to facilitate lenticule dissection. 9 Nevertheless, enhancement using reSMILE is currently off-label and considered as cumbersome by most surgeons, and has not yet been proven to be equivalent to alternative established options. Moreover, reSMILE retreatment is difficult or even impossible for enhancement of low residual refractive errors, as the lenticule will eventually become too thin for a successful dissection. ...
Purpose:
To provide an overview of the currently available retreatment methods after myopic small-incision lenticule extraction (SMILE).
Design:
Systematic literature review.
Methods:
The PubMed library was searched for articles containing the terms "small-incision lenticule extraction" and "enhancement" or "retreatment". The last search was performed on May 1, 2019.
Results:
In contrast to laser in-situ keratomileusis (LASIK), which can be retreated by a flap relift, repeat SMILE retreatment is currently not approved and only seldomly performed. As substitutes, surface ablation, cap-to-flap conversion using the CIRCLE program in the VisuMax platform, and thin-flap LASIK have been recently established. While all options offer comparable safety and efficacy to LASIK retreatments, each has its patient-specific advantages and disadvantages. While surface ablation preserves the flap-free approach of the primary procedure, the aspect of pain and a slow visual recovery might render it less attractive as compared with CIRCLE and thin-flap LASIK which offer quick recovery, however at the price of flap creation. Besides, each retreatment method generates specific tissue responses and has a different impact on corneal biomechanics, which is strongly dependent on the previous SMILE parameters, especially the cap thickness.
Conclusions:
Refractive enhancement after SMILE is currently mostly performed by surface ablation, CIRCLE cap-to-flap conversion or thin-flap LASIK, which all offer safety and efficacy comparable to LASIK retreatments. In this review, a detailed overview over each method, its technical aspects, and specific advantages and disadvantages is given.
Purpose:
To evaluate the long-term visual and refractive outcomes, optical quality, and stability of the cornea and axial length after small incision lenticule extraction (SMILE) for the correction of high myopia with a maximum myopic meridian exceeding 10.00 diopters (D).
Methods:
Via a prospective cohort study, 53 eyes (53 patients) with a maximum myopic meridian exceeding 10.00 D were corrected with a VisuMax femtosecond laser (version 3.0; Carl Zeiss Meditec AG, Jena, Germany) at the Zhongshan Ophthalmic Center of Sun Yat-sen University. Refractive outcomes, aberrations, axial length, and corneal curvature were evaluated preoperatively and at 1, 3, and 15 months postoperatively.
Results:
At 15 months postoperatively, the efficacy and safety indexes were 0.91 ± 0.25 and 1.15 ± 0.18, respectively. A total of 72% of eyes were within ±0.50 D and 89% were within ±1.00 D of the attempted spherical equivalent, respectively. From 1 to 15 months postoperatively, the significant regression was -0.24 ± 0.28 D (P < .001) on manifest refraction and -0.43 ± 0.54 D (P < .001) on anterior corneal curvature. In addition, a significant increase of 0.20 µm (P = .016) was observed in the spherical aberration. No significant change was observed in posterior corneal curvature (P > .999), including mean keratometry or astigmatism, or in the ocular axis length from 1 to 15 months postoperatively (26.82 ± 0.93 and 26.82 ± 0.95 mm, respectively, P > .99).
Conclusions:
SMILE had long-term safety, efficacy, and predictability when treating high myopia with a maximum myopic meridian exceeding 10.00 D. Both a manifest refraction regression of -0.24 D and a significant spherical aberration increase of 0.20 µm were observed between 1 and 15 months postoperatively, due to the increased anterior corneal curvature. [J Refract Surg. 2019;35(1):31-39.].
