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Learning curve for small incision lenticule extraction (SMILE) of a novice corneal laser refractive surgeon evaluated by procedure time for consecutive cases

Session Details

Session Title: Refractive Femtosecond

Session Date/Time: Sunday 06/10/2013 | 17:00-18:30

Paper Time: 17:00

Venue: Elicium 2 (First Floor)

First Author: : K.Pradhan NEPAL

Co Author(s): :    D. Reinstein   G. Carp   T. Archer   M. Gobbe     

Abstract Details


To investigate the learning curve for small incision lenticule extraction (SMILE) by evaluating the procedure time for the first 80 cases and 20 cases after 1 years’ experience.


Tilganga Institute of Ophthalmology, Kathmandu, Nepal


This was a retrospective analysis of 100 patients who underwent a SMILE procedure performed using the VisuMax femtosecond laser (Carl Zeiss Meditec) by KRP at the Tilganga Institute of Ophthalmology. The population included the first 80 consecutive patients treated (between 09/01/2012 and 10/05/2012) and a group of 20 consecutive patients treated one year later (between 17/02/2013 and 07/03/2013). The surgeon, KRP, had no previous practical experience of any corneal laser refractive surgical procedure. For each patient, the internal microscope video of the right eye was reviewed and the procedure time was recorded defined as starting from the first contact of the cornea to the contact glass and ending when the speculum was removed. The procedure time was plotted for consecutive cases and the mean procedure time was calculated for each group of 10 cases.


The SMILE procedure time decreased gradually over the course of the first 50 cases. The mean procedure time (number <5 minutes, number <4 minutes) for each group of 10 patients was: [1] 6’43" (1, 0), [2] 7’08" (0, 0), [3] 6’37" (0, 0), [4] 4’47" (8, 1), [5] 4’54" (5, 0) , [6] 5’34" (2, 0) , [7] 5’07" (6, 2) , [8] 4’35" (7, 4). The SMILE procedure time was also lower after 1 years’ experience: 4’00" (18, 12) for the 20 cases analyzed.


The learning curve for SMILE, for a novice surgeon with no previous corneal laser refractive surgery experience, requires approximately 40 patients to be able to consistently perform a unilateral procedure in <5 minutes. A small further decrease was observed after the first year such that the majority of procedures were performed in <4 minutes.

Financial Interest:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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