Abstract

Background: Small-incision lenticule extraction (SMILE) is a relatively novel refractive procedure introduced to correct myopia and myopic astigmatism using femtosecond technology. Aim: The aim of this study was to prospectively assess the predictability, efficacy and safety of SMILE surgery. Setting: The study took place in Alyamama Vision Refractive Center, Baghdad, Iraq. Methods: In this prospective, non-randomised, single-centre clinical study, all patients with myopia or myopic astigmatism underwent the SMILE procedure performed by one surgeon (H.S.S.) with a targeted post-operative refraction of 0 to −0.5 dioptres (D). The procedure was performed using the VisuMax femtosecond platform. Post-operative data, including slit-lamp examination and measurements of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction, and intraocular pressure (IOP), were recorded. Results: A total of 141 eyes of 76 patients (51 females and 25 males) were included in the study. The mean preoperative spherical equivalent (SE) (−4.37 D ± 1.65 D) ranged from −2.0 D to −10.25 D after 2 years of follow-up, and the mean post-operative SE (−0.06 D ± 0.18 D) ranged from −0.75 D to 0.63 D. A UCVA of 20/40 or better was noted in 98% of the eyes at the 2-year follow-up. Most of the surgical complications, which were seen in 30 eyes, did not result in permanent visual loss. Corneal abrasion was the most common surgical complication, constituting 10.6% of all complications, followed by adherence of the lenticule to the cap (3.5%). Conclusion: The SMILE procedure is effective with high safety and efficacy, and its complication rate will probably decrease with improvement in the surgeon experience level and refinement of the laser parameters.

Highlights

  • Small-incision lenticule extraction (SMILE) is a relatively novel refractive procedure introduced to correct myopia and myopic astigmatism using femtosecond technology

  • The first outcomes with femtosecond lenticule extraction (FLEX) were published in 2008, whilst the first outcomes with SMILE appeared in 2011.2,3

  • Small-incision lenticule extraction involves the removal of an intrastromal lenticule that is incised using a femtosecond laser; this lenticule is comparable to the tissue ablated with excimer laser in Laser-assisted in situ keratomileusis (LASIK) surgery.[6]

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Summary

Introduction

Small-incision lenticule extraction (SMILE) is a relatively novel refractive procedure introduced to correct myopia and myopic astigmatism using femtosecond technology. Laser-assisted in situ keratomileusis (LASIK) is considered a basic standard laser vision correction procedure for myopia and myopic astigmatism.[1] Small-incision lenticule extraction (SMILE) is a relatively new method for correcting myopia up to −12.0 dioptres (D) and astigmatism up to −5.0 D. This technology is currently only available from Carl Zeiss Meditec AG (Jena, Germany) and can be used for femtosecond lenticule extraction (FLEX) and SMILE. The SMILE procedure is speculated to avoid some of the flap-related complications of LASIK, like flap displacement, traumatic flap dislocation and flap wrinkles.[2]

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