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Visualization crucial for LASIK enhancement after SMILE

Issue: November 10, 2017

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Glenn I. Carp

LISBON, Portugal — LASIK enhancement after small incision lenticule extraction can be a safe and effective procedure, but visualizing the original interface is crucial to avoid complications, according to one speaker.

“Our standard SMILE (Carl Zeiss Meditec) protocol as a primary procedure is to create a 135-µm cap, and if you plan a 100-µm flap you are very unlikely to buttonhole or cross over into the underlying interface. However, the bottom line when you do these procedures is to be able to visualize the original interface. You should never create another interface without being able to visualize the original one,” Glenn I. Carp, MD, said at the European Society of Cataract and Refractive Surgeons meeting.

In a study, the first 4,000 SMILE eyes treated at the London Vision Clinic were analyzed. A total of 100 LASIK enhancements were performed. The range of spherical equivalent treated was –1.88 D to +1.50 D.

“We created a larger flap than the original SMILE interface diameter, which was 8 mm. In doing so, we could not be dissecting into the original SMILE opening incision,” Carp said.

Visual acuity results were excellent, with 83% of the eyes achieving 20/20 and no patient losing more than one line of best corrected visual acuity. Accuracy was also very good, with 80% of the patients within 0.5 D and 96% within 1.00 D of intended correction.

Best results were obtained in the hyperopic population.

Suction loss occurred in 1% of the eyes, and SMILE incision tear occurred in 2% of the eyes.

“Again, remember that if you go into the SMILE interface and lift the flap, you end up ablating into the residual stromal thickness, possibly beyond the 250 µm safety threshold. So it is mandatory to visualize where the original SMILE interface is,” Carp said. – by Michela Cimberle

Reference:

G. Carp, et al. Outcomes of LASIK retreatment after SMILE. Presented at European Society of Cataract and Refractive Surgeons meeting; Oct. 7-11, 2017; Lisbon, Portugal.

Disclosure: Carp reports receiving travel expenses from Carl Zeiss Meditec.