Copenhagen 2016 Registration Programme Exhibitor Information Virtual Exhibition Satellite Meetings Glaucoma Day 2016 Hotel Star Alliance

10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits


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Retreatment strategies following small incision lenticule extraction (SMILE): in vivo tissue response and clinical results

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Session Details

Session Title: Presented Poster Session: Laser Refractive Surgery (Lasers/LASIK/Epi-LASIK)

Session Date/Time: Sunday 11/09/2016 | 09:30-11:00

Paper Time: 09:50

Venue: Poster Village: Pod 2

First Author: : J.Mehta SINGAPORE

Co Author(s): :    A. Riau   C. Lim   Y. Liu        

Abstract Details


Small Incision Lenticule Extraction (SMILE) is an all-in-one femtosecond laser-assisted flapless refractive procedure. With any refractive correction, there may be initial under/overcorrection or regression causing a residual refractive error, that requires a retreatment procedure. Here, we investigated the tissue responses following various retreatment procedures in a rabbit model of SMILE, followed by reporting the clinical outcomes of a method of retreatment.


Singapore Eye Research Institute, Singapore National Eye Centre


All rabbits underwent a -6.00D correction. Two weeks later, the rabbits underwent -1.00D enhancement by either: (i) VisuMax Circle, which was followed by stromal excimer ablation (S+C); (ii) secondary SMILE anterior to the primary procedure (S+SE); or (iii) surface ablation (S+P). The rabbits were followed up for up to 28 days. The clinical results of 10 cases of enhancement with LASEK supplemented with 0.02% mitomycin-C (m-LASEK) after SMILE were reported.


In rabbits, S+P induced significantly more CD11b- and TUNEL-positive cells (p<0.001 compared to other procedures), corneal edema, and haze. S+SE and S+C resulted in clear cornea, and similar levels of fibronectin expression. However, S+C resulted in significantly more inflammatory (p=0.001) and apoptotic cells (p<0.001) compared to S+SE. The 10 patients who underwent m-LASEK enhancement all demonstrated clear cornea and improved uncorrected distance visual acuity.


In summary, S+SE offers several advantages over other methods. However, depending on the degree of enhancement, the lenticule may become too thin to be extracted and more difficult to perform than S+C and S+P. S+P offers a simple technique, which maintains the corneal integrity by avoiding the need of flap creation. However, the employment of S+P enhancement has to be supplemented by mitomycin-C to eliminate haze development

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