ESCRS - FP20.12 - Circle Keratorefractive Enhancement After Smile Myopia Correction.

Circle Keratorefractive Enhancement After Smile Myopia Correction.

Published 2024 - 42nd Congress of the ESCRS

Reference: FP20.12 | Type: Free paper | DOI: 10.82333/c4e5-2b13

Authors: Rainer Wiltfang* 1 , Martin Bechmann 1 , Nikolaus Feucht 1 , Amir M. Javadi 1 , Siegfried G. Priglinger 2 , Nikolaus Luft 2

1Smile Eyes,Munich,Germany, 2Department of Ophthalmology,Ludwig Maximilian University,Munich,Germany

Purpose

To evaluate the visual outcomes of keratorefractive enhancement using the VisuMax® CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), following prior small incision lenticule extraction (SMILE), which converts the SMILE cap into a femtosecond LASIK flap for secondary excimer laser application.

Setting

Smile Eyes Clinic, Munich, Germany
Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany

Methods

A total of 245 eyes of 194 patients were evaluated, who underwent post-SMILE refractive enhancement with the CIRCLE technique between January 2014 and November 2023. Based on our clinical data, an average of 1.6 % of SMILE procedures lead to an enhancement. SMILE and CIRCLE were performed using the VisuMax® (Carl Zeiss Meditec AG) platform. Excimer laser ablation was performed with the MEL 90® (Carl Zeiss Meditec AG) platform. Mean spherical equivalent (MRSE), corrected and uncorrected distance visual acuity (CDVA and UDVA) were measured before SMILE, before CIRCLE enhancement as well as 1 day, 1 week, 6 weeks and one year thereafter.

Results

Mean time between SMILE and CIRCLE was 19 ± 20 (range 3 to 102) months. Median follow up after CIRCLE was 9 months. MRSE was -4.8 ± 2 (-9.38 to -0.25) D before SMILE, and -0.58 ± 0.73 (-2.75 to +1.5) D before CIRCLE. MRSE after CIRCLE aiming for plano target refraction (n = 225 eyes) was -0.12 ± 0.38 D at 1 week, and -0.05 ± 0.22 D at 1 year postoperatively. UDVA was 0.03 ± 0.06 logMAR at 1 year postoperatively and CDVA remained stable or improved after CIRCLE (each with p value <0.001 in repeated measure ANOVA). A total of 82.4 % of plano-targeted eyes achieved equal or better UDVA after 1 year than CDVA before CIRCLE resulting in an efficacy index of 0.98±0.10. Two eyes (0.8 %) lost 2 lines of CDVA translating into a safety Index of 1.00.

Conclusions

The CIRCLE technique is a safe and effective option for enhancement after SMILE in myopic eyes. Flap creation through CIRCLE allows achieving the previously planned or a new target refraction, which enables augmenting or reversing monovision in presbyopic post-SMILE patients.