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PRK yields good results as enhancement after SMILE
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LISBON, Portugal — PRK enhancement after small incision lenticule extraction yields good results, according to a study presented here.
“SMILE (Carl Zeiss Meditec) is known to have a lower regression rate than LASIK, but a recent publication has shown a rate of approximately 0.5 D after 5 years, with enhancement in 2.1% and 2.9% of the cases at 1 and 2 years,” Martin Dirisamer, MD, PhD, FEBO, said at the European Society of Cataract and Refractive Surgeons meeting.
There is no consensus yet on which is the best re-treatment technique after SMILE. A repeat SMILE is an off-label procedure and is not recommended by Zeiss. LASIK is still somewhat controversial, and PRK, which might be the safest procedure, has the downside of pain and slow visual rehabilitation.
In a retrospective analysis of SMILE procedures performed in Marburg and Munich, Germany, and in Linz, Austria, 43 eyes (2.2%) out of 1,963 were re-treated. Manifest refraction spherical equivalent (MRSE) before PRK was 0.86 D.
Time from SMILE to PRK was approximately 10 months. A standard protocol for PRK with mitomycin C for 20 to 30 seconds was used.
“The target was plano refraction, and we used different ablation profiles,” Dirisamer said. “Significant reduction of MRSE was achieved after 1 week and was stable at 3 months. [Uncorrected visual acuity] improvement occurred slowly, as expected, over 6 weeks, but again was stable at 3 months. [Corrected distance visual acuity] after 6 weeks was equal to CDVA preop.”
Only one patient had significant haze, which resolved after 3 months with topical medications. There were two cases of undercorrection, one occurring in the patient with the highest pre-SMILE spherical equivalent.
“We had some major overcorrection in two cases with +1.75 D and +1.38 D. We used different ablation profiles in our PRK procedures, and both patients had been treated with the ASA profile, which tends to overcorrect eyes with low MRSE,” Dirisamer said.
“Long-term results are necessary, especially to compare PRK with other techniques, such as secondary SMILE and LASIK,” he said. – by Michela Cimberle
Reference:
Dirisamer M, et al. Visual recovery after surface ablation re-treatment for myopic SMILE. Presented at European Society of Cataract and Refractive Surgeons meeting; Oct. 7-11, 2017; Lisbon, Portugal.
Disclosure: Dirisamer reports he is a consultant for Carl Zeiss Meditec, Örtli, TRB Chemedica and ASKIN.