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Circle an option for SMILE enhancement
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SAN FRANCISCO — Using VisuMax Circle enhancement after SMILE results in less pain and a shorter recovery time than surface ablation, according to a speaker here.
“We do not repeat SMILE to enhance patients who have received SMILE treatment,” Jakob Siedlecki, MD, said at Refractive Surgery Subspecialty Day at the American Academy of Ophthalmology annual meeting.
Many surgeons use LASIK; however, squeezing a flap, even if thin, onto a thin SMILE cap can be difficult. Many then use surface ablation, but patients may experience pain and a slow recovery time.
“For this reason, Circle is a very good third option,” Siedlecki said. “Circle might be the least impactive on the patient’s recovery, and it’s painless.”
Circle (Carl Zeiss Meditec) is not yet approved by the FDA in the United States, but it is widely used in Germany and other areas of Europe, Siedlecki said.
The procedure consists of creating a junction cut to open a new treatment plane, creating a side cut with a hinge and then performing the excimer laser ablation.
Two studies regarding Circle were recently completed, the first a retrospective review of patients who had received the procedure and the second comparing it to the standard of care of surface ablation.
“The refractive accuracy is comparable to surface ablation. We have an efficacy index of 0.97, and we have 89% of patients with 20/20 UDVA,” Siedlecki said.
Introducing a flap in what was to be a flapless procedure runs the risk for biomechanical weakening, and for this reason, Siedlecki recommended using Circle in patients with a cap of 135 µm or less.
“If a flap would not be a problem, and we counsel our patients that even after performing SMILE we might need a flap to re-treat, then cap thickness is one of the most important guiding factors,” he said. – by Rebecca L. Forand
Reference: Siedlecki J. CIRCLE enhancement after myopic SMILE. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: Siedlecki reports no relevant financial disclosures.