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Surface ablation effective after myopic SMILE
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Surface ablation with the addition of mitomycin C is a safe and effective enhancement method after myopic SMILE, according to a study.
The databases of three SMILE Eyes Clinics in Germany and Austria that included 1,963 eyes that underwent myopic SMILE were retrospectively reviewed.
Surface ablation enhancement was performed in 43 eyes of 31 patients (2.2%), using either the MEL 80 or the MEL 90 excimer laser (Carl Zeiss Meditec). Four ablation algorithms were used, including the TSA, ASA and topography-guided profiles on the MEL 80 and the Triple-A mode on the MEL 90. To prevent haze, mitomycin C was used in all eyes.
Mean spherical equivalent decreased from 0.86 D + 0.43 D before to 0.03 D + 0.57 D at 3 months after surface ablation. The number of patients within + 0.50 D and + 1.0 D increased from 22.5% to 80% and from 72.5% to 92.5%, respectively.
Uncorrected distance visual acuity significantly improved at 6 weeks and remained stable over the 3 months of follow up. Corrected distance visual acuity worsened at week 1 but returned to baseline and stabilized at week 6.
Two eyes treated with the ASA profile had significant overcorrection. The authors do not recommend the use of this profile in these cases because of the fixed amount of induced asphericity, which is not suited for the correction of low myopia.
“Choosing the optimal enhancement method after SMILE remains a highly debatable topic,” the authors noted. LASIK with a flap created superficially over the SMILE pocket, or with a deeper flap converting the pocket into a full flap might be options. However, surface ablation might be a better alternative treatment “preserving possible advantages of a flap-free approach.” – by Michela Cimberle
Disclosure: Siedlecki reports no financial interest. Please see the study for the other authors’ financial disclosures.
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