Management Of Myopia Regression After Relex Smile Surgery Without Surgery

Relex-Smile is a surgical laser technique for the correction of refractive errors. It is minimally invasive and safe although some publications question the long term refractive stability. Certain studies describe myopic progression in up to 80% of treated eyes. In these cases, it is necessary to discuss what options do we have when visual acuity is no longer satisfactory. Leaving aside surgical options, contact lenses are an ally to satisfy the demands of patients without the risk of taking a second surgery. Among them, night orthokeratology allows the patient not to need to wear contacts during the day simulating the effect of a refractive surgery. To date, there is only one published clinical case that uses OK in post-surgery with Smile.

Centro Oftalmológico Integral – MIRANZA COI Bilbao. Rodríguez Arias 6º, Bilbao (Basque Country), Spain.

A 30-year-old caucasian man, who underwent SMILE surgery in 2018 with a prior refraction of OD -8.00 (-0.50) x 155º, 0.0LogMAR and OS -7.50 (-0.75) x 5º, 0.0 LogMAR. He attended our clinic in April 2023 reporting blurred distance vision, caused by a myopic shift after the surgical process. Our patient showed a spontaneous visual acuity of 0.3 OD and 0.2 OS LogMAR. We found a manifest refraction of OD -0.75 (-0.75) x 180º and OS -1.0.

To obtain a successful OK fitting we provided him with two pairs of lenses. Our initial lenses selection was based upon the pre-surgical topographic measurements. The desired effect was not achieved after two weeks of use, because we found a manifest refraction of -0,50 (-0,25) x 180º OD and -0,25 OS to reach 0.0 LogMar in both eyes. We decided to change only the base curve to reduce the residual myopia. With the second pair, and after two weeks of night use, our patient reached a spontaneous vision of -0.05 and -0.10 LogMAR respectively. The patient does not report changes in vision throughout the day or other visual complaints.

Fitting post-rx corneas with OK can be challenging because of their oblate shape. An accurate centration and the correction of the desired myopia is the main achievement. Fluorescein pattern can be uneven due to a bigger tear meniscus, caused by the oblate morphology of the cornea. Successfully, we finally reached a good vision and centration of the lenses with the customization of OK lenses.

As we have seen, it is possible to fit ortho-k lenses in patients undergoing refractive surgery. Our patient shows visual acuity and comfort values throughout the day comparable to non-operated patients. Until the date of publication of this clinical case, the ocular surface shows no alterations and topographic stability of the treatment area is observed.

To our knowledge, this is the second published case of success in an ortho-k adaptation post SMILE at a global level. Long-term follow-up of these patients is necessary to guarantee the safety of the technique, but the results are promising.