Official ESCRS | European Society of Cataract & Refractive Surgeons

To evaluate the safety and initial outcomes of SMILE Xtra (ReLEx SMILE with accelerated cross linking) in patients with high myopia and borderline topography.

Session Details

Session Title: Cornea
Session Date/Time: Sunday 22/02/2015 | 08:30-11:00
Paper Time: 10:18
Venue: Hall 2
First Author: : S.Ganesh INDIA
Co Author(s): :    S. Brar              

Abstract Details


To describe a new technique, SMILE Xtra, which may safely allow laser refractive correction in patients with higher refractive errors ie spherical equivalent (SE) upto -10D) and borderline corneas for thickness (<480µ) and suspicious topography without increasing risk of ectasia in future.


Nethradhama Super Speciality Eye Hospital, Bangalore, India.


Eligible candidates first underwent ReLEx SMILE surgery for correction of myopic refractive error. Following removal of lenticule through 2mm superior incision, 0.1-0.2ml riboflavin(0.25% riboflavin in saline ) was applied to the interface and allowed to diffuse for 60 seconds. Interface was washed and exposed to UV-A radiation at 45 mW/ cm2 to facilitate cross-linking for 75 seconds. Total energy delivered was 3.4 J/cm2. Mean follow up was at least 12 months.


SMILE Xtra was performed in 40 eyes of 20 patients, with pre op mean spherical equivalent -5.026 ± 2.06 D, mean pachymetry 501.3 ±10.06 µ , mean keratometry 45.46 ± 1.40 D and average endothelial cell density (ECD) 2872 cells/mm². At 12 months post op, mean residual SE was -0.32 ± 0.22 D, mean pachymetry 414.8 ±15.36 µm , K mean 41.28 ± 2.20 and mean ECD 2764.3 cells/mm² . Stromal line of demarcation was seen at mean depth of 225.7 ±18.4 µm . There were no intraoperative complications or postoperative haze .None of the eyes had loss of BCVA.


SMILE Xtra may to be a safe and promising modality to prevent corneal ectasia in thinner corneas / borderline topography and higher refractive errors. However, longer follow-up is required to evaluate the efficacy and refractive stability of the cornea.

Financial Disclosure:


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