Background: Small-incision lenticule extraction (SMILE) is a relatively novel refractive procedure introduced to correct myopia and myopic astigmatism using femtosecond technology.Aim: The aim of this study was to prospectively assess the predictability, efficacy and safety of SMILE surgery.Setting: The study took place in Alyamama Vision Refractive Center, Baghdad, Iraq.Methods: In this prospective, non-randomised, single-centre clinical study, all patients with myopia or myopic astigmatism underwent the SMILE procedure performed by one surgeon (H.S.S.) with a targeted post-operative refraction of 0 to −0.5 dioptres (D). The procedure was performed using the VisuMax femtosecond platform. Post-operative data, including slit-lamp examination and measurements of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction, and intraocular pressure (IOP), were recorded.Results: A total of 141 eyes of 76 patients (51 females and 25 males) were included in the study. The mean preoperative spherical equivalent (SE) (−4.37 D ± 1.65 D) ranged from −2.0 D to −10.25 D after 2 years of follow-up, and the mean post-operative SE (−0.06 D ± 0.18 D) ranged from −0.75 D to 0.63 D. A UCVA of 20/40 or better was noted in 98% of the eyes at the 2-year follow-up. Most of the surgical complications, which were seen in 30 eyes, did not result in permanent visual loss. Corneal abrasion was the most common surgical complication, constituting 10.6% of all complications, followed by adherence of the lenticule to the cap (3.5%).Conclusion: The SMILE procedure is effective with high safety and efficacy, and its complication rate will probably decrease with improvement in the surgeon experience level and refinement of the laser parameters.

Objective: The purpose of this study is to assess the predictability, safety, efficacy and stability of correction of refractive errors in patients with keratoconus using Visian implantable collamer lens (ICL) following collagen cross-linking. Materials and methods:This prospective, non-comparative study evaluated 20 eyes of 14 patients with keratoconus subjected to implantation of intraocular collamer lens at least 1 year following collagen cross-linking and stable refraction. Mean preoperative myopia was -8.43 ± 5.13 Diopters (D) (-3.5 to -20.0D and mean cylinder was -2.19 ± 1.28D (0.0 to -4.5D). The preoperative spherical equivalent (SE) was -9.52 ± 5.33D (-3.75 to -21.25D). During the 12 months follow-up, uncorrected visual acuity, best corrected visual acuity, refraction, intraocular pressure and vaulting are measured. results: At 12 months postoperatively, 90% of eye had refractive cylinder of <1.0D with (p = 0.003) and 20 (100%) eyes was within ±0.75D of sphere at 1 year (r 2 = 0.99) and (p = 0.0085). The mean postoperative BCVA in decimal was 0.498 ± 0.232, while the mean preoperative BCVA was 0.484 ± 0.285. The safety index at 12 months was 1.02. The mean postoperative UCVA in decimal was 0.498 ± 0.232 and the mean preoperative BCVA is 0.484 ± 0.29 and the efficacy index at 12 months was 1.01. conclusion: Implantation of Visian Intraocular collamer lens is predictable, safe and effective way to correct refractive error in patients with keratoconus following collagen cross-linking.