Small incision lenticule extraction (SMILE) techniques: patient selection and perspectives

Area of Science:

• Ophthalmology
• Refractive Surgery
• Corneal Surgery

Background:

• Small Incision Lenticule Extraction (SMILE) is a preferred refractive surgery for myopia and myopic astigmatism.
• It offers advantages in precision, biomechanical stability, and ocular surface health compared to other procedures.
• SMILE demonstrates comparable safety, efficacy, and predictability to femtosecond laser-assisted in situ keratomileusis (FS-LASIK), with higher patient satisfaction.

Purpose of the Study:

• To review patient selection criteria for SMILE procedures.
• To analyze various surgical techniques for SMILE, including their advantages and disadvantages.
• To provide insights for refractive surgeons, particularly those new to the SMILE procedure.

Main Methods:

• A comprehensive MEDLINE search was conducted using keywords: "small incision lenticule extraction," "SMILE," and "refractive lenticule extraction."
• The review synthesizes information on patient selection and surgical techniques for SMILE.
• Analysis includes pros and cons of different SMILE surgical approaches.

Main Results:

• SMILE has a steeper learning curve than flap-based procedures, posing challenges for novice surgeons.
• Modifications to the SMILE technique have been developed to simplify lenticule extraction and reduce complications.
• Optimal patient selection is crucial; novice surgeons should avoid complex cases like low myopia or high astigmatism.

Conclusions:

• SMILE is a widely accepted refractive surgery technique with significant benefits.
• Careful patient selection and mastering surgical techniques are essential for successful SMILE outcomes.
• Further evolution of a standardized technique is anticipated to broaden SMILE's applicability and improve results.