Official ESCRS | European Society of Cataract & Refractive Surgeons

Combined flapless refractive lenticule extraction [Smile] and intrastromal cross- linking in mild keratoconus. Refractive and bio-mechanical outcomes

Session Details

Session Title: Refractive
Session Date/Time: Sunday 22/02/2015 | 08:30-11:00
Paper Time: 10:18
Venue: Sadirvan A
First Author: : M.Abdalla EGYPT
Co Author(s): :    O. Ibrahim   A. Elmassry   A. Zahran        

Abstract Details


To report visual,refractive, topographic and biomechanical outcomes of simultaneous small inicsion lenticule extraction [SMILE] and intrastromal crosslinking in eyes with abnormal topography and forme fruste keratoconus.


International Femto Laser Center [IFLC] Cairo ,Egypt


59 eyes of 33 patients. Inclusion criteria: topographic diagnosis of forme fruste KC,stable refraction and topographic findings at least 1 year, BCVA>0.7, CCT >480u, patient age >21 years, follow up at 1 day, 1 week,1,3,6,9,12 months. UCVA, BCVA, manifest refraction, topographic, clinical evaluation, IOP and biomechanical stability of the cornea are assessed. All cases had a 100u cap and 300u residual stromal bed followed by intra-pocket injection of isotonic riboflavin 3 times with a 5 minute interval then 5 min 18 mw/cm2 UV cross-linking. Bio-mechanical stability was assessed using the Corvis ST, measuing and correlating IOP and deformation amplitude.


Mean patient age was 29.4+/-5.63. Mean preoperative UCVA 0.13+/-0.08 and 0.82+/-0.13 postoperative. Mean preoperative refraction was -3.97±1.87 D sphere and -2.85 D cylinder, mean postoperative SER was -0.14±0.73 D mean astigmatism was -0.18 ± 0.45 D. 72% within +/- 0.5 and 89% within +/- 1.0 D. 3 eyes lost 1 line of BCVA, 1 eyes lost 2 lines and 1 eye due to haze. All patients presented intrastromal haze that improved during the follow-up. Mean deformation amplitude was 1.38 mm ±0.29 pre-op. to 1.19 mm ±0.29 postop while pre and post operative IOP showed no significance.


Combined SMILE and crosslinking might be a safe predictable and stable treatment option in patients where conventional laser refractive surgery is contraindicated. Further follow-up and larger samples are needed.

Financial Disclosure:

One or more of the authors receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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