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Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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SMILE or CRY: a case report

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Session Details

Session Title: Presented Poster Session: Refractive Surgery New Techniques/Instrumentation/Devices II

Venue: Poster Village: Pod 2

First Author: : J.Langer GERMANY

Co Author(s): :    N. Luft   E. Messmer   S. Freissinger   S. Priglinger   W. Mayer           

Abstract Details


To report an interesting case of a patient who had to receive penetrating keratoplasty after myopic femtosecond laser-assisted small incision lenticule extraction (SMILE).


University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany.


We present a case of a 26-year-old woman with complete corneal scarring after complicated myopic SMILE on the right eye who was referred to our hospital. The spherical equivalent before laser treatment was -4.38D on the right eye and -4.00D on the left eye and topography showed a with-the-rule astigmatism on both eyes. The documented laser procedure was uneventful but wrong separation of the lenticule made a complete extraction of the lenticule not possible. The postoperative spherical equivalent showed -4.125D with an irregular astigmatism due to corneal scarring throughout the complete corneal stroma documented in OCT measurements.


Due to serious anatomical changes of the cornea an uneventful penetrating keratoplasty was performed. Histological analyzes of the cornea revealed scar formation and epithelial cysts within the stroma. The postoperative uncorrected visual acuity was 0.8 logMAR and 0.2 logMAR with contact lens after successful corneal transplantation.


SMILE procedure should be carefully performed as especially the lenticule separation and extraction can be a surgical challenge. In doubt, separation of the lenticule should not be enforced as it may lead to devastating outcome as presented in this case.

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