Enhancement Strategies And Refractive Outcomes After Smile Versus Femtosecond Lasik: A Single-Center Retrospective Experience (2023–2026)
Published 2026 - 44th Congress of the ESCRS
Reference: PP10.05 | Type: Free paper | DOI: 10.82333/zfz1-2073
Authors: A/Prof. Gonul Karatas Durusoy* 1 , Dr Mehmet Altun 1 , Dr Mevlüt Celal Öcal 1 , Dr Hüsna Topçu 1 , Prof. Dr Dilek Yasa 2 , A/Prof. Bülent Köse 1
1Ophthalmology,Aritmi Osmangazi Hospital,bursa,Türkiye, 2Ophthalmology,Istinye University,Istanbul,Türkiye
Purpose
To describe enhancement patterns and refractive outcomes in eyes requiring reoperation for residual refractive error after SMILE and femtosecond LASIK in a high-volume refractive surgery center.
Setting
Single-center, high-volume refractive surgery clinic at Aritmi Osmangazi Eye Hospital (Bursa, Türkiye).
Methods
We retrospectively reviewed all refractive laser procedures performed at Aritmi Osmangazi Eye Hospital between 2023 and 2026. Cases with incomplete records or insufficient follow-up were excluded. In the enhancement cohort, primary procedure type (SMILE or femtosecond LASIK), enhancement technique (LASIK, PRK, Circle LASIK), timing to enhancement, and refractive outcomes were analyzed. Spherical equivalent (SE) was assessed preenhancement and at the first and final post-enhancement visits. Group differences in enhancement technique by primary procedure were evaluated using chi-square testing, and paired changes in SE were assessed with Wilcoxon signed-rank tests.
Results
Among 1,693 SMILE-treated eyes, 5 (0.29%) required enhancement; among 600 femtosecond LASIK-treated eyes, 17 (2.83%) required enhancement. In enhanced eyes (n=22), retreatment was LASIK in 19 (86.4%), PRK in 2 (9.1%) and Circle LASIK in 1 (4.5%); technique differed by primary procedure (p=0.0027). Median time to enhancement was 7 months (3–18; n=21). Mean SE improved from −3.40±2.02 D pre-enhancement to −0.10±0.30 D at final follow-up (p<0.001). No complications occurred.
Conclusions
In this single-center experience, enhancement after SMILE required a more heterogeneous approach (LASIK, PRK, or Circle LASIK), whereas enhancements after femtosecond LASIK were consistently managed with reLASIK. Across techniques, enhancement effectively reduced residual refractive error and achieved near-emmetropic outcomes at final follow-up without observed complications. Larger analyses including non-enhanced eyes are warranted to quantify enhancement rates and identify predictors of retreatment after SMILE versus femtosecond LASIK