Corneal Interlayer Healing Smoothness And Its Correlation With Visual Quality After Smile, Smile Pro, And Wavelight Plus Surgeries

To evaluate corneal interlayer healing smoothness and its relationship with higher-order aberrations (HOAs) following three different refractive surgeries: SMILE, SMILE PRO, and WaveLight Plus.

Department of Ophthalmology, Liaoning Aier Eye Hospital, Shenyang, China. This prospective study was conducted from June 2025 to February 2026.

This prospective/retrospective (please specify) comparative study included patients who underwent corneal refractive surgery, divided into three groups: SMILE (56 eyes), SMILE PRO (45 eyes), and WaveLight Plus (83 eyes). Follow-up examinations were performed at 1 day, 1 week, 1 month, and 3 months postoperatively.
Corneal interlayer healing smoothness was assessed using retroillumination images obtained by Pentacam Wave; the area of interlayer microplies was quantified using ImageJ software. Ocular optical quality was evaluated by measuring total higher-order aberrations , horizontal coma , vertical coma , horizontal trefoil, oblique trefoil , spherical aberration , horizontal tetrafoil, and oblique tetrafoil using Pentacam Wave. 

Corneal Healing Smoothness:
Microfold area decreased significantly from 1 day to 3 months postoperatively in the SMILE and SMILE PRO groups , but remained stable in the WaveLight Plus group. At 1 day and 1 week, microfold areas in the SMILE and SMILE PRO groups were comparable  and both were significantly larger than in the WaveLight Plus group. By 3 months, microfold areas were similar across all three groups .

Higher-Order Aberrations:
All groups showed significantly increased total HOAs and individual components at each postoperative visit versus preoperative baseline . Total HOAs decreased significantly from 1 week to 3 months in all groups , paralleling the improvement in corneal healing smoothness.

All three refractive procedures yielded favorable corneal healing and visual quality outcomes. WaveLight Plus surgery was associated with a smoother interlayer interface in the early postoperative period, while SMILE PRO demonstrated accelerated healing, achieving smoothness comparable to WaveLight Plus by 1 month postoperatively. By 3 months, interlayer smoothness and HOAs converged across all groups. The temporal concordance between improved healing smoothness and reduced HOAs suggests that optimizing the early postoperative interlayer environment may contribute to better visual quality.