‘Excellent’ refractive outcomes, few complications seen in large SMILE cohort
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A large population of young myopic patients who underwent SMILE surgery achieved excellent refractive and visual outcomes, at least equivalent to modern LASIK, according to a speaker.
A total of 3,997 SMILE procedures performed in patients with myopia or myopic astigmatism since 2012 at the London Vision Clinic were retrospectively analyzed. The treated spherical equivalent was up to –9 D, and cylinder was up to –6 D.
“All patients had BCVA 20/20 or better prior to surgery, and 95% achieved 20/20 or better unaided after surgery. The vast majority gained lines of vision or had no change, and only three patients lost two or more lines of BCVA. The first had some black spots in the lenticular interface and regained baseline BCVA with transepithelial PTK. The other two patients had cystic epitheliopathy secondary to anterior basement membrane dystrophy, again resolved with PTK treatment,” Alastair Stuart, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Predictability was high, with 100% of patients within ±1 D and 88% within ±0.5 D of attempted spherical equivalent. Cylinder correction was close to the intended target, with less than 1 D of residual astigmatism in 99% of eyes and less than 0.5 D in 91% of eyes. There was no loss of contrast, but rather a tendency toward gaining contrast.
There were few intraoperative and postoperative complications. Lenticular remnants were seen in 0.1% of eyes and removed on the same day. Suction loss occurred in 0.45% of eyes, and the treatment was completed on the same day with SMILE or LASIK. The most common postoperative complication was diffuse lamellar keratitis in 10 eyes, managed with topical corticosteroid drops in eight cases and with interface washout in two cases. Epithelial ingrowth occurred in six patients, managed with cap lift in two cases and with YAG in four cases.
“Infection rate was zero in a nearly 4,000-eye cohort,” Stuart said.
Four cases of postoperative ectasia were reported.
“We retrospectively analyzed these patients and found no abnormal preoperative parameters. We concluded that these patients must have been eye rubbers,” Stuart said.
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Stuart A, et al. Refractive outcomes including vector analysis in 3,997 consecutive SMILE procedures for spherical and compound myopic astigmatism. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 8-11, 2021; Amsterdam.
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