Abstract
Following the early work by Sekundo et al. and Shah et al., small incision lenticule extraction (SMILE) using the VisuMax femtosecond laser (Carl Zeiss Meditec) has become increasingly popular. The accuracy of the lenticule dimensions has been verified using very-high-frequency digital ultrasound and optical coherence tomography. Visual and refractive outcomes and safety have been shown to be similar to LASIK. A number of studies have demonstrated a lower reduction and faster recovery of corneal sensitivity and subbasal nerve fiber density after SMILE than LASIK, as expected since the anterior stroma is disturbed only by the small incision. The potential biomechanical advantages of SMILE have been modeled based on the nonlinearity of tensile strength through the stroma. Extraction of an intact lenticule has also given rise to new applications such as cryopreservation of the lenticule for later reimplantation, and a new procedure, endokeratophakia, in which a myopic SMILE lenticule is implanted into a hyperopic patient.
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