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Enhancement after myopic SMILE using surface ablation

Poster Details

First Author: J.Siedlecki GERMANY

Co Author(s):    N. Luft   D. Kook   W. Mayer   S. Priglinger   W. Sekundo   M. Dirisamer     

Abstract Details


As compared to laser in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE) offers on par results concerning safety and efficacy for myopia correction, but no straightforward secondary enhancement method due to the absence of a flap to re-lift. This study was conducted to report the feasibility and outcomes of secondary surface ablation after SMILE, which, in contrast to the other methods available (LASIK with flap creation or cap-to-flap conversion), preserves the advantages of a flap-free procedure.


Department of Ophthalmology, Ludwig Maximilians-University Munich, Germany; SMILE Eyes Clinic Munich, Germany; SMILE Eyes Clinic Linz, Austria; SMILE Eyes Refractive Center at the University Eye Hospital Marburg, Germany; Cabinet de Chirurgie R�Ã�©fractive, Senningerberg, Luxembourg.


The databases of four individual SMILE Eyes centers were screened for patients who had undergone surface ablation enhancement after myopic SMILE. Out of 43 eyes (2.2 %), 40 eyes of 28 patients with a follow up of at least three months were included in the analysis. SMILE and surface ablation were performed in the usual manner. After enhancement, Mitomycin C was applied to prevent haze.


Retreatment was performed after a mean 9.82 �Â�± 5.27 months for a residual SE of -0.86 �Â�± 0.43 D. At three months, SE was 0.03 �Â�± 0.57 D (p<0.0001) and the number of patients within 0.5 D from plano increased from 27.5 to 80.0 %. UCVA improved from 0.23 �Â�± 0.20 to 0.08 �Â�± 0.15 logMAR (p<0.0001). CDVA remained unchanged (0.01 �Â�± 0.07 before versus -0.01 �Â�± 0.05 logMAR after retreatment; p=0.99). Safety and efficacy were 1.06 and 0.90. In contrast to good results with the Triple-A, TSA and Topography guided profiles, the aspherically optimized profile (ASA) induced significant overcorrection.


Combined with the intraoperative application of Mitomycin C, surface ablation seems to be a safe and effective method of secondary enhancement after SMILE. Due to the usually low residual myopia, the ASA profile is not recommended in these cases.

Financial Disclosure:

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

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