Official ESCRS | European Society of Cataract & Refractive Surgeons


Combined flapless refractive lenticule extraction (SMILE) and intrastromal corneal cross-linking in patients with suspicious topography and/or thin corneas: refractive and biomechanical outcomes

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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: 17:39

Venue: Free Paper Forum: Podium 3

First Author: : M.Abdalla EGYPT

Co Author(s): :    K. Nagy   O. Ibrahim                          

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.


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Prospective case series of 118 eyes of 66 patients.Inclusion criteria were topographic diagnosis of forme fruste KC,stable refraction and topographic findings for at least 1 year, BCVA>0.7, central corneal thickness >460u, 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 assessed.SMILE was preformed ,all cases had a 100u cap and 300u residual stromal bed followed by intra-pocket injection of isotonic riboflavin then 3 min 30 mw/cm2 UV cross-linking.Bio-mechanical stability was assessd using the Corvis ST measuring and correlating IOP and deformation amplitude.


Mean patient age was 29.4+/-5.63(22-35).Mean preoperative UCVA 0.13+/-0.08 and 0.82+/-0.13 postoperative. Mean preoperative refracton was -3.97±1.87 D sphere(range -6.0 to -1.25) and -2.85 D cylinder (range -0.75 to -4.25),mean postoperative SER was -0.14±0.73 D (range -1.25 to +1.5)mean astigmatism was -0.18 ± 0.45 D. 72% within +/- 0.5 and 89% within +/- 1.0 D. 2 eyes lost 1 line of BCVA, 1 eyes lost 2 lines due to haze. Some 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 is 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:

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

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