Safety And Efficacy Of Smile In Hiv-Positive Patients With Sustained Viral Suppression: A Case Series Of 18 Eyes
Published 2025 - 43rd Congress of the ESCRS
Reference: FP14.08 | Type: Free paper | DOI: 10.82333/m6eb-jv88
Authors: Jingqi Huang* 1 , Yizhi Liu 2 , Qiongyan Tang 3
1Changsha Aier Eye Hospital, Aier Eye Hospital Group,Changsha,China;Zhongshan Ophthalmic Center, Sun Yat-sen University,Guangzhou,China, 2Zhongshan Ophthalmic Center, Sun Yat-sen University,Guangzhou,China, 3Changsha Aier Eye Hospital, Aier Eye Hospital Group,Changsha,China
Purpose
To our knowledge, this is the first case series evaluating small incision lenticule extraction (SMILE) surgery in human immunodeficiency virus-positive (HIV-positive) patients. We aimed to evaluate the safety and efficacy of SMILE in HIV-positive patients with sustained viral suppression and preserved immune function.
Setting
Beijing Aier Eye Hospital, China
Methods
Retrospective analysis of 9 HIV-positive patients (18 eyes) who underwent SMILE between July 2022 and September 2024. Inclusion criteria: CD4+ T-lymphocyte count ≥400 cells/μL, undetectable viral load (<40 copies/mL), and stable antiretroviral therapy (ART) ≥3 months.
Surgical Protocol: Standard VisuMax® SMILE procedure. Enhanced occupational protection measures were implemented for medical staff, while the surgical protocol remained consistent with that for HIV-negative patients.
Analysed parameters included age, gender, time since HIV diagnosis, ART regimen, CD4 counts, viral load, intraoperative complications, postoperative uncorrected visual acuity (UCVA), and postoperative complications.
Results
All patients were male (21–37 years old) with preoperative spherical equivalents ranging from -2.00D to -8.50D. Duration of HIV infection varied from 3 months to 10 years; one patient tested serologically positive for syphilis.
No intraoperative complications occurred. Postoperative UCVA reached ≥20/20 in 17 eyes (94.4%) at 1 day and 18 eyes (100%) by 1 week. Transient dry eye symptoms resolved to preoperative levels within 3 months. Ocular Surface Disease Index (OSDI) scores: 12.3 → 18.7 → 13.1 (baseline → postoperative 1 month → 3 months). No cases of infectious keratitis, diffuse lamellar keratitis, or delayed epithelial healing were observed.
Conclusions
Preliminary evidence suggests that SMILE can be safely performed in ART-controlled HIV-positive patients with intact immune function, demonstrating safety and efficacy comparable to non-HIV populations. CD4+ T-lymphocyte count ≥400 cells/μL, undetectable viral load, and stable ART ≥3 months may serve as safe surgical thresholds. However, larger multicenter studies with extended follow-up are required to establish definitive guidelines.