Enhancement Options After Myopic Small-Incision Lenticule Extraction (SMILE): A Review. Issue 5 (September 2019)

• Record Type: Journal Article
• Authors: Siedlecki, Jakob; Luft, Nikolaus; Priglinger, Siegfried G.; Dirisamer, Martin
• Is Part Of: Asia-Pacific journal of ophthalmology. Volume 8:Issue 5(2019)
• Publication Date: 2019-09
• Subjects: CIRCLE -- enhancement -- laser in situ keratomileus -- small incision lenticule extraction -- surface ablation; Ophthalmology -- Periodicals; Eye -- Diseases -- Periodicals; Periodicals; 617.7005
• DOI: 10.1097/APO.0000000000000259
• Languages: English
• ISSNs: 0129-1653

Abstract

Abstract : Purpose: To provide an overview of the currently available retreatment methods after myopic small-incision lenticule extraction (SMILE). Design: Systematic literature review. Methods: The PubMed library was searched for articles containing the terms "small-incision lenticule extraction" and "enhancement" or "retreatment". The last search was performed on May 1, 2019. Results: In contrast to laser in-situ keratomileusis (LASIK), which can be retreated by a flap relift, repeat SMILE retreatment is currently not approved and only seldomly performed. As substitutes, surface ablation, cap-to-flap conversion using the CIRCLE program in the VisuMax platform, and thin-flap LASIK have been recently established. While all options offer safety and efficacy comparable to LASIK retreatments, each has its patient-specific advantages and disadvantages. While surface ablation preserves the flap-free approach of the primary procedure, the aspect of pain and a slow visual recovery might render it less attractive as compared with CIRCLE and thin-flap LASIK which offer quick recovery, however at the price of flap creation. Besides, each retreatment method generates specific tissue responses and has a different impact on corneal biomechanics, which is strongly dependent on the previous SMILE parameters, especially the cap thickness. Conclusions: Refractive enhancement after SMILE is currently mostly performed by surface ablation, CIRCLE cap-to-flap conversion or thin-flap LASIK, which all offer safety and efficacy comparable to LASIK retreatments. In this review, a detailed overview over each method, its technical aspects, and specific advantages and disadvantages is given.