ESCRS - PP27.05 - Beyond Smartsight: A Comparative Evaluation Of Prk, Lasik, And Klex Enhancements In 59 Post-Smartsight Eyes

Beyond Smartsight: A Comparative Evaluation Of Prk, Lasik, And Klex Enhancements In 59 Post-Smartsight Eyes

Published 2025 - 43rd Congress of the ESCRS

Reference: PP27.05 | Type: Free paper | DOI: 10.82333/vnh4-qb45

Authors: Vishal Kumar* 1 , Somya Kumari 1 , Namrata Sharma 2

1OPHTHALMOLOGY,KASHYAP MEMORIAL EYE HOSPITAL,RANCHI,India, 2OPHTHALMOLOGY,AIIMS, NEW DELHI,NEW DELHI,India

Purpose

To investigate the rate and rationale for surgical enhancements after primary SmartSight procedures and compare outcomes among different enhancement techniques—including PRK, conversion of cap to flap, and a secondary SmartSight treatment—in a large cohort of 2698 eyes over multiple years.

 

Setting

Eye clinic Svjetlost, Zagreb, Croatia

Methods

We retrospectively analyzed 2698 post-SmartSight eyes, of which 59 (2.19%) required retreatment. Notably, most enhancements occurred within the first two years. Over the last 12 months, among 1200 eyes treated, the retreatment rate dropped to 0.5%. Enhancements were indicated by residual refractive error (mean spherical equivalent of −0.75 D, range +1.25 to −1.50 D, with astigmatism over 0.75 D), optical zone or visual axis mismatch, and higher-order aberrations (HOAs) (n=6). Techniques included surface ablation (PRK) in 31 eyes, cap-to-flap conversion using the Schwind ATOS edge-cut function in 27 eyes (1 needing PRK after conversion failure, and 1 flap complication), and a repeat SmartSight in 1 eye under the existing cap.

 

Results

PRK enhancements were uncomplicated but entailed a longer recovery. In contrast, cap-to-flap conversion and secondary SmartSight delivered rapid, pain-free recovery with minimal downtime from postoperative day one. Despite these early postoperative differences, the long-term visual results across all enhancement methods were comparable, and flap-related complications were minimal.

 

Conclusions

Enhancement after SmartSight was required in only 2.19% of cases overall, with most re-treatments occurring early in the experience. The retreatment rate in the last 12 months—0.5% among 1200 eyes—underscores continued improvements and a possible learning-curve effect. Regardless of the enhancement technique, outcomes were safe and effective, with no significant differences in final visual acuity. Flap-based methods offered faster early recovery, whereas PRK, though equally successful long-term, required a longer healing period.