Comparing The Existing Myopic Keratorefractive Lenticule Extraction (KLEx) Platforms: A Narrative Review

Area of Science:

• Ophthalmology
• Corneal Surgery
• Refractive Surgery

Background:

• Kerato-refractive lenticule extraction (KLEx) is an advancing surgical technique for myopia correction.
• Several platforms exist, each with unique laser parameters and surgical approaches.

Purpose of the Study:

• To compare laser settings, visual outcomes, and higher order aberrations (HOAs) among five myopic KLEx platforms.
• To identify factors influencing visual recovery, refractive accuracy, and HOA induction.

Main Methods:

• A narrative review of 26 articles published up to April 2025.
• Literature search conducted across PubMed, Scopus, and Embase databases.
• Focus on SmartSight, CLEAR, SILK, SMILE, and SMILE Pro platforms.

Main Results:

• SmartSight showed superior 1-day visual acuity (79% 20/20) compared to SILK (63%).
• High predictability (≥85%) for spherical equivalent and excellent astigmatism correction (≥87%) at 6 months across CLEAR, SILK, SMILE, and SMILE Pro.
• All platforms increased HOAs, notably vertical coma, while demonstrating safety, efficacy, and refractive stability.

Conclusions:

• Low pulse energy and high frequency may enhance early visual outcomes in KLEx.
• All reviewed KLEx platforms offer safe, effective, and stable refractive correction for myopia.
• Understanding platform-specific laser parameters is crucial for optimizing patient outcomes.