Small-incision lenticule extraction in a patient with high astigmatism and nystagmus

Small-incision lenticule extraction (SMILE) was performed in a patient with high astigmatism and nystagmus. The patient presented for a refractive surgery evaluation with a manifest refraction of -0.50 -6.00 × 137 (20/40^-1) in the right eye and -2.25 -2.25 × 30 (20/40^-1) in the left eye. The patient was deemed suitable for corneal laser refractive surgery. Consideration was given to SMILE, laser in situ keratomileusis, and photorefractive keratectomy. It was decided SMILE was the best option given that the refractive portion of the procedure is performed while the cornea is immobilized by suction. The treatment was uneventful, and the final manifest refraction was +0.25 -0.25 × 130 (20/40) in the right eye and +0.25 diopter sphere (20/40) in the left eye. Topography was normal, showing a well-centered treatment zone. This case highlights an additional use for SMILE, given its ability to immobilize the cornea during treatment.