CORNEAL ABERRATIONS AFTER SMALL-INCISION LENTICULE EXTRACTION IN HIGH MYOPIA

Management of high degree aberrations with scleral lenses.

Small incision lenticule extraction ( SMILE ) is a myopic astigmatism correction surgery characterized as minimaly invasive and flap free procedure. High operative aberration in the postoperative period could compromise the visual quality leading to symptoms like glare, haloes, monocular diplopia and reduced CS.

A 27-year-old male patient (right eye: -8.75DS, left eye: -9.00DS) underwent bilateral small incision lenticule extraction. Two weeks after SMILE surgery patient examination revealed UDVA in the OD was 20/25 and in the OS 20/25. The intraocular pressure was measured with tonoref (NIDEK, JAPAN )  and was 5 mmHg in the right eye and 6 mmHg in the left eye. Slit lamp and fundus examination was normal in both eye. Corneal topography (OCULUS PENTACAM, GERMANY) founded horizontal decentration of optic zone of treatment. Coma and spherical aberration were found to be consistently affected in corneal aberrometry ( NIDEK, JAPAN ) . The patient refused new laser treatment, so he was fitted with scleral lenses. Spherical aberration and coma decreased significantly and the patient was satisfied. 

Decentration is one of the serious postoperative complications of SMILE procedure. Induction of coma is associated with the magnitude of decentration and spherical aberration was associated with the magnitude of the dioptric correction. Scleral lenses can help patients to improve visual acuity.