Small-incision lenticule extraction (SMILE) is becoming the procedure of choice in treating myopia and myopic astigmatism. With great comparability in terms of visual outcome with the femtosecond laser-assisted in situ keratomileusis (FsLASIK) procedure, the method is characterized by better patient satisfaction and less postoperative dry eye induction. Moreover, it has the advantages of better eye surface stability and biomechanical strength compared to FS-LASIK. The method is now globally accepted among refractive surgeons. Patients suitable for the procedure must meet criteria for keratorefractive procedures generally. Our current clinical experience suggests that the lenticule extraction procedure delivers promising refractive results in terms of predictability, efficacy, and safety.

Background: Corneal ectasia is a sight-threatening complication of corneal refractive surgery characterized by progressive steepening and thinning of the cornea and subsequent loss of best-corrected visual acuity. Objective: To report the clinical outcomes following treatment of post-laser in situ keratomileusis (LASIK) induced ectasia. Methods: This is a retrospective case series of 7 patients (10 eyes) which developed post-LASIK ectasia. In these cases of postoperative ectasia, the presented clinical signs were either forme fruste keratoconus, thin cornea, posterior elevation map value > +15.0µm, or residual stromal bed < 300µm. All cases were treated with either collagen crosslinking (CXL) alone or combined with PRK or CXL and phakic intraocular implant using the Dresden protocol and a slight modification thereof. In all cases, the flap was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15±12.88µm), and refractive error was corrected using the Wavelight Allegretto excimer laser. Results: Average preoperative corrected visual acuity (CDVA) was 0.75 (±0.26) Snellen. Postoperative CDVA significantly increased to 0.86 (±0.13) Snellen (p=0.04, paired t-test). One eye lost three lines of its baseline CDVA (before ectasia), while all other eyes regained lines of CDVA. All cases remained stable during the follow-up. Conclusion: Several surgical procedures are used for the management of corneal ectasia. However, the best surgical approach should be determined based on the state of progression of the disease. Although ectasia remains a potentially devastating complication after refractive surgery, most patients can regain functional visual acuity with appropriate management, and corneal transplantation is infrequently indicated.