Clinical Outcomes Of Secondary Surgery Performed Within 24 Hours After Small-Incision Lenticule Extraction Failure
Published 2025 - 43rd Congress of the ESCRS
Reference: FP14.12 | Type: Free paper | DOI: 10.82333/xm9k-ft70
Authors: Covadonga Menéndez Acebal* 1 , Néstor Ventura 1 , Núria Domenech 1 , Mireia Hereu 1 , Anna Camos 1 , Julia Seco 1 , Lucas Moura 1 , Sara Marin 1 , Ainhoa De Castellarnau 1 , Nerea Perez 1 , Irene Vila 1 , Cristobal Matías Perez 1 , Elisabet Simo 1 , Alba Galdón 1 , Alicia Pereira 1 , Anabel Rodriguez 1 , Marta Pazos 1
1Ophthalmology,H. Clínic de Barcelona,Barcelona,Spain
Purpose
To evaluate the clinical outcomes of secondary surgery performed within 24 hours after small-incision lenticule extraction (SMILE) failure and compare these outcomes with those of uneventful SMILE.
Setting
Nuri Eye Hospital, Daejeon, South Korea.
Retrospective case series.
Methods
This retrospective study included 69 eyes from 36 patients. Among them, 38 eyes underwent secondary surgery within 24 hours after SMILE failure due to suction loss (31 eyes), black spots (3 eyes), or insufficient intrastromal laser energy delivery (4 eyes). The secondary surgery procedures included photorefractive keratectomy (PRK, 5 eyes), programmed restart (22 eyes), and secondary SMILE (11 eyes). The remaining 31 contralateral eyes underwent uneventful SMILE and served as the control group. Surgical outcomes, including visual acuity, manifest refraction, keratometry, and corneal wavefront aberrations, were assessed at 6 months postoperatively.
Results
The mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were −0.04 ± 0.06, −0.04 ± 0.06, and −0.36 ± 0.43 diopters (D), respectively, in the uneventful SMILE group; −0.02 ± 0.08, −0.02 ± 0.04, and −0.23 ± 0.65 D, respectively, in the PRK group; −0.04 ± 0.06, −0.04 ± 0.06, and −0.14 ± 0.59 D, respectively, in the programmed restart group; and −0.07 ± 0.08, −0.07 ± 0.08, and −0.26 ± 0.44 D, respectively, in the secondary SMILE group (P = 0.955, 0.154, and 0.298, respectively). There were no significant differences in the changes in HOA-RMS, COMA-RMS, vertical coma, horizontal coma, trefoil, or spherical aberration among the four groups.
Conclusions
Secondary surgery performed within 24 hours after SMILE failure resulted in clinical outcomes comparable to those of uneventful SMILE at 6 months postoperatively. No significant differences were observed in visual acuity, refractive outcomes, or corneal wavefront aberrations among the groups. These findings suggest that secondary SMILE following SMILE failure is a viable option with satisfactory visual and refractive outcomes.