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Comparison of the biomechanical change and clinical outcomes between combined small incision lenticule extraction (SMILE) and collagen cross-linking versus SMILE for high myopic correction

Poster Details

First Author: H.Cheon SOUTH KOREA

Co Author(s):                        

Abstract Details


To compare the corneal biomechanical properties and visual and refractive outcomes of small-incision lenticule extraction (SMILE) and SMILE combined with corneal collagen cross-linking (SMILE-CXL) surgery for high-degree myopia.


BGN eye clinic, Seoul, South Korea


Medical records of patients with spherical equivalent (SE) greater than -6.00 diopters (D) treated with SMILE alone, SMILE-CXL were reviewed. The SMILE group comprised 126 eyes of 63 patients while it was 130 eyes of 65 patients in the SMILE-CXL group. Uncorrected distance visual acuity (UCVA), SE and corneal haze were followed up in both groups for 24 months. Corneal hysteresis (CH) and the corneal resistance factor (CRF) parameters were determined using the Ocular Response Analyzer (ORA) preoperatively and at 1 day, 1 week, 3 months, 12months and 24 months postoperatively


Postoperatively, there were no statistically significant differences in UCVA between the SMILE and SMILE-CXL groups. The averages of the absolute value of SE were 0.34 �Â�± 0.25 D and 0.42 �Â�± 0.34 D in both groups, respectively (P = 0.04). Both groups produced no significant corneal haze. Both types of surgery were associated with statistically significant decreases in CH and the CRF at postoperative day 1 (both P < 0.01). In both groups, the decreases subsequently stabilized with no further deteriorations compared to postoperative day 1. Both groups showed similar biomechanical changes at each time point (all P > 0.05).


The SMILE and SMILE-CXL surgery appear to be safe and effective for high-degree myopic correction. Both the SMILE and SMILE-CXL groups resulted in a decrease in CH and the CRF at postoperative 1 day, with the decreases stabilizing after this point. There were no significant differences between the effects of the SMILE and SMILE-CXL on corneal biomechanical properties for 2 years.

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