[SMILE: refractive lenticule extraction for myopic correction]

It is currently possible to obtain refractive correction without using an excimer laser; the technique is called ReLEx(®) (Refractive Lenticule extraction) and uses the femtosecond laser VisuMax(®) (Carl Zeiss Meditec, Jena, Germany). We present initial clinical experience with small-incision (4mm) lenticule extraction (SMILE) for the treatment of moderate to high myopia via a retrospective study of 106 myopic and astigmatic eyes.

This retrospective study of 106 eyes measures postoperative visual acuity to determine the safety, efficacy and predictability of the technique. For SMILE, an intrastromal lenticule is cut with the VisuMax(®) femtosecond laser; it is then dissected and detached from the anterior and posterior stromal planes and finally removed through a 4mm incision. This procedure does not require the creation of a flap. The study is based on 106 eyes of 54 patients who underwent the surgery for moderate to high myopia, with or without associated astigmatism. Patient selection was the same as for LASIK.

The average age of the patients was 33 ± 9 (20-54). The mean preoperative spherical equivalent was -6.22 ± 1.6 (-3; -9.75 D). The mean preoperative sphere was -5.88 D ± 1.52 (-3; -9.75 D) with a mean cylinder of -0.68 D ± 0.58 (0.00; -2.25). Postoperatively, 95% of patients had distance vision greater than or equal to 8/10. No loss of BCVA was noted. The mean postoperative spherical equivalent was -0.16 ± 0.35 D (-1.38; +0.88) with a mean sphere of 0.00 ± 0.34 D (-1,25; +1) and a mean cylinder of -0.31 ± 0.37 D (0; -1.5). One eye was converted to PRK because the incision site was covered by conjunctiva during the last 5 seconds of the laser phase.

SMILE is a predictable and safe technique for the surgical correction of moderate to high myopia.