Long-term follow-up shows stability of flapless corneal reshaping

TOKYO — After almost 5 years of follow-up in a large number of patients, the ReLEx smile procedure is showing several advantages over LASIK, including for the treatment of high myopia, according to one speaker.

“The procedure preserves the anterior stroma, which is the strongest, thus maintaining better corneal biomechanics and leading to a significantly reduced risk of ectasia,” Osama Ibrahim, MD, said at the World Ophthalmology Congress.

Aberrations induced by the flap are avoided, dry eye is less because fewer nerves are severed, and quality of vision is better, he said.

Ibrahim has now treated more than 3,000 eyes with the ReLEx procedure (Carl Zeiss Meditec), and about 1,000 have a complete follow-up, some up to 5 years.

With the procedure, he was able to treat cases that were not suitable for LASIK.

“Even if the stroma is less than 250 µm or even 200 µm, you can still get a safe procedure. In suspicious cases, cross-linking can be performed,” he said.

The procedure allows correction as low as –1.5 D and up to –15 D of myopia, and up to 6 D of astigmatism. At 2 years, 80% of Ibrahim’s cases were within ±0.5 D of intended correction, and more than 95% were within ±1 D.

“Stability is striking,” he said. “What you get at 1 month is what you get at more than 2 years. High myopic eyes also have no regression.”

Safety is a main concern. Some of Ibrahim’s first cases lost one or two lines because of lack of experience, but as the learning curve and laser parameters improved, only 1% of cases lost one line. Most cases gained two lines or more.

“The safety profile was exactly the same for the high myopic group,” he said.

Disclosure: Ibrahim is a consultant to Carl Zeiss Meditec.