Surgical options for retreatment after small-incision lenticule extraction: Advantages and disadvantages

Since the inception of small-incision lenticule extraction (SMILE), many surgeons have speculated the lack of an adequate and standard retreatment procedure will impede its popularity. However, more than 1 million patients worldwide have had this surgery, with visual outcomes nearly equivalent to current laser in situ keratomileusis (LASIK) results. With the procedure's growing popularity, some patients will inevitably have a postoperative residual refractive error from regression, overcorrection, undercorrection, and astigmatic induction and will require retreatment. To our knowledge, literature reviewing major retreatment options is limited. Options include surface ablation, thin-flap LASIK, secondary small-incision lenticule extraction, and a cap-to-flap procedure (CIRCLE) in which a femtosecond laser is use to create cuts that convert the small-incision lenticule extraction cap into a LASIK flap. This review discusses major advantages and disadvantages of these options and compares the visual outcomes based on the existing literature. An algorithmic approach created from this analysis is presented to guide retreatment decision-making.