Ophthalmology Lectures: one of new refractive surgery trends is SMILE procedure..let's talk about it ..

1. JUST SMILE
SMALL INCISION LENTICULE EXTRACTION/Dr.Diyar j.k.

3. RELEX SMILE
 is a relatively new refractive procedure designed to
treat a multitude of refractive errors such as myopia,
hyperopia, presbyopia, and astigmatism. The
procedure involves using a femtosecond laser to
create a corneal lenticule which is extracted whole
through a small incision without the use of an
excimer laser
 It is flapless ,bladeless procedure
 Currently, ReLEx SMILE corrects myopia from up to
−10.00 D, myopic astigmatism up to −5.00 D and a
spherical equivalent (SE) of up to −12.5D

5.  Biomechanical stability : 75% vs 54% , Corneal
hysteresis (CH) &corneal resistance factor
(CRF)after SMILE and LASIK have shown
no differences in low myopia but documented
differences in moderate and high myopia cases
 Corneal sensation & Reinnervation :

6.  Wound healing & inflammatory reactions : less
keratocyte apoptosis & inflammation. , in low myopic
treatment, they found a disparity in the inflammatory
response induced by tissue manipulation .
 Clinical Assessments & Outcomes
Efficacy : 90-100% UCVA 2040 D1& more at 3 mo & 6
mo
Predictability : good , 85–98% of eyes being within
±0.50D of target refraction, 96–100% within ±1.00D of
target refraction at 3 mo. 96–100% within ±1.00D of
target refraction at 6 mo.
Stability : is also good; the postoperative refraction
appears to be stable within one week, with a mean SE
regression ranging from −0.11–0.14D at 3 mo.,−0.17–
0.10D at 6 mo..
safety : the majority (70–100%) of the eyes maintain or
improve their (CDVA) postoperatively

7.  Contrast sensitivity : is reported to be better than
that in femtosecond-LASIK patients.
 HOA : It is reported that the HOA mainly coma
& spherical aberration increased after
SMILE.However,the induction of HOAs is
significantly lower in SMILE patients than in
femtosecond-LASIK patients
 Topographic changes :The treatment zone is
observed as a slightly prolated & well-centered area
after SMILE

9. SURGICAL TECHNIQUE

10. Complications

13.  The Mx of suction loss depends on the surgical step
at which it occurs : stage 1 (posterior lenticule cut
<10%), restart; stage 2 (posterior lenticule cut >
10%), switch to LASIK; stage 3 (lenticule side cut),
repeat the lenticule side cut & decrease the
lenticule diameter by 0.2 to 0.4 mm; stage 4 (anterior
lenticule cut), repeat the anterior lenticule cut; and
stage 5 (anterior lenticule side cut), repeat the
anterior lenticule side cut and decrease the lenticule
diameter by 0.2 to 0.4 mm.

14. POST OP. COMPLICATION
 Minor epithelial abrasions at the incision (7%),
difficulty in removing the lenticule (2%), small tears
at the incision (2%)
 Transient corneal haze and dryness : commenest at
week 1 postoperatively
 Dry eye symptoms are commonly seen
postoperatively, it resolves in most cases by 3
mo. With lubricant treatments
 Epithelial islands at incision, fiber in interface,
infiltrates/keratitis, monocular ghost images, and
interface inflammation
 As any ref. procedure ( under crr.

15. ENHANCEMENT
 Is considered only when stability has been
demonstrated, defined as a change in SE refraction
within ±0.25D in three months
 The only enhancement option reported clinically
utilized (PRK) procedure. The authors reported that
PRK with MMC was able to improve visual
symptoms of the patients after complicated SMILE
cases.
 perform secondary SMILE anterior/posterior to
the primary SMILE.
 conversion of the cap into a flap with a
larger diameter than the original cap by
using the VisuMax Circle software

16. FUTURE…CRYOPRESEVED LENTICULE ..HYPEROPIA

17. IS IT REALLY MAKE THE PATIENT SMILE

18. VS

19. THANK YOU