Official ESCRS | European Society of Cataract & Refractive Surgeons


Long-term clinical outcomes of small incision lenticule extraction with accelerated corneal cross-linking (SMILE Xtra): two-year results

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Session Details

Session Title: Small Incision Lenticule Extraction II

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:33

Venue: Free Paper Forum: Podium 3

First Author: : H.Koo SOUTH KOREA

Co Author(s): :    S. Kim   D. Lee                          

Abstract Details


To compare long-term safety, efficacy and predictability of SMILE Xtra with SMILE. Also, to find out the clinical effect of Xtra in different patient subgroups.


Nunemiso Eye Clinic, Seoul, Republic of Korea.


Patients with moderate risk according to the Randleman ectasia score system who had undergone SMILE Xtra from March 2016 to March 2017 were collected and retrospectively reviewed. Study group was divided into 3 subgroups and clinical outcomes were analyzed. Matched control group of patients with SMILE alone was set for the proper analysis. For Xtra protocol, 90 seconds of 0.25% Rivoflavin soaking followed by 60 seconds of UV-A radiation of 30mW/cm2 was done. Uncorrected distant visual acuity, corrected distant visual acuity, manifested refraction, tomography, wavefront aberration, anterior segment OCT and specular microscopy were checked pre and postoperatively.


Pre-op mean spherical equivalent(SEQ) was -5.25±1.88D for SMILE and -6.74±2.19D for SMILE Xtra. Mean corneal thickness(CCT) was 537.3±28.6um for SMILE and 530.9±30.1um for SMILE Xtra. Post-op visual acuity of SMILE verses SMILE Xtra at day 1 was 0.94±0.15 and 0.79±0.22, however, it was 1.14±0.22 and 1.13±0.23 at 2-year. Efficacy index was comparable(1.16 verses 1.13). Safety index was 1.16, and it showed good predictability(R2= 0.985) for SMILE Xtra group. Mean endothelial cell count difference was 106.6±254.7 verses 165.1±565.3 but there was no statistical significance. No significant differences were noticed within subgroups.


Long-term visual outcomes of SMILE Xtra showed comparable results with SMILE. Safety or predictability was not affected by combined crosslinking procedure. Different subtype characteristics of moderate risk subjects did not affect the final clinincal results. Thus, SMILE with accelerated cross-linking may be an effective and safe strategy for moderate risk patients.

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