ReLEx SMILE is a new flapless and bladeless refractive eye surgery procedure that treats myopia, hyperopia, astigmatism, and presbyopia using a femtosecond laser to extract a corneal lenticule through a small incision. The procedure has demonstrated efficacy with high predictability and safety, with a significant percentage of eyes maintaining or improving their vision postoperatively. Complications are generally minor, though transient symptoms like dry eyes and corneal haze may occur, resolving in most cases within three months.

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