Bilateral Small Incision Lenticule Extraction (SMILE) After Penetrating Keratoplasty

To report a case of successful bilateral small incision lenticule extraction (SMILE) performed on a patient who had penetrating keratoplasty and astigmatic keratotomy in the right eye and penetrating keratoplasty in the left eye.

Case report.

Astigmatic keratotomy was used to reduce astigmatism of the right eye because astigmatism was higher than the maximum correction limitation of SMILE. Bilateral SMILE was performed afterward. Although there were no difficulties during lenticule separation and removal of the right eye, wound dehiscence occurred during lenticule separation of the left eye. Two sutures were used at both ends of the incision, and the remainder of the procedure was successfully completed. Visual acuity improved to 20/50 in both eyes without correction, and the corrected distance visual acuities were 20/50 and 20/30 in the right and left eyes, respectively, at the 6-month postoperative visit.

SMILE is a potentially effective alternative in correcting refractive errors in patients following penetrating keratoplasty. However, studies with a larger patient population with longer follow-up periods are needed to confirm these initial findings. [J Refract Surg. 2016;32(9):644-647.].