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Small incision lenticule extraction (SMILE): assessment of the learning curve – initial results and complications

Poster Details

First Author: M.Orts Vila SPAIN

Co Author(s):    P. Tañá Rivero   C. Tello Elordi   M. Ramos Alzamora   M. Milla Barrios     

Abstract Details


To report the clinical results of the SMILE procedure for the correction of myopia and myopic astigmatism as well as to assess the learning curve describing the main complications observed intra and postoperatively.


Clínica vistahermosa, Oftalvist, Alicante. Spain.


The Visumax femtosecond laser system was used to perform small incision lenticule extraction to treat refractive errors. The laser was used to cut a refractive lenticule intrastromally to correct myopia (range: -1.25 to -8.25 diopters (D)) and myopic astigmatism (range -0,25 to -1.5 D). The lenticule was then extracted from the stroma through a 3 to 4.63 mm incision. Outcome mesures were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA) and manifest refraction at the end of the follow-up.


The study comprised 56 eyes of 29 patients. Mean spherical equivalent (SE) preoperatively was -4.95D ±1.91 and -0.2D ±0.45 postoperatively. Mean follow up was 3 months. CDVA preoperatively was 0.99D ±0.06 and 0.98 ±0.07 postoperatively. UDVA postoperatively was 0.95 ±0.13. Two eyes lost 1 line of CDVA: one due to a mild diffuse lamellar keratitis and one because of a small epithelial self-limited ingrowth. Two intraoperatively important complications were reported. In the first case the surgeon mistook the posterior plane for the anterior, so that he made minimal injuries in the stroma underneath trying to find the posterior plane. In this case a side cut incision was made and the lenticule was peeled from the undersurface of the flap. In the second case suction loss occurred during the femtosecond laser pass during the creation of the anterior surface of the lenticule (the posterior surface and vertical edge had already been created). Only this part of the procedure was repeated. The surgeon was not able to dissect the lenticule and waited for one week to finally find it and complete the lenticule extraction under the operating microscope. No clinical complications were seen in these two eyes.


SMILE is an excellent technique. It is safe, predictable and effective in treating myopia and myopic astigmatism. It offers significant clinical and practical benefits. However it is more complicated surgically than a laser in situ keratomileusis (LASIK). SMILE technique requires some surgical skill and a short learning curve for an expert refractive surgeon.

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