Surgical instruments for small incision lenticule extraction (SMILE)

Liu, Yu-Chi

doi:10.1080/17469899.2016.1187065

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…Various instruments have been developed for interface separation, the recent designs having a blunt circular tip. [ 14 ] The lower layer is then dissected in a similar fashion. During separation, the eye may be stabilized with a fixation forceps to have better control while separating the surgical planes.…”

Section: Principles and Surgical Techniquementioning

confidence: 99%

Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm

Ganesh

Brar

Arra

2018

Indian J Ophthalmol

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Small incision lenticule extraction (SMILE), a variant of refractive lenticule extraction technology is becoming increasingly popular, as a flapless and minimally invasive form of laser vision correction (LVC) for the treatment of myopia and myopic astigmatism. This review aims at summarizing the principles, surgical technique, and clinical outcomes in terms of visual and refractive results, safety, efficacy, postoperative dry eye, aberrations, and biomechanics of SMILE and its comparison with other conventional techniques of LVC, such as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Recent advancements in the laser frequency and energy delivery patterns, instrumentation, and surgical techniques have shown significant improvement in the visual recovery and outcomes after SMILE, compared to the initial results published by Sekundo and Shah et al. Most of the recently published literature on long-term outcomes of SMILE shows excellent stability of the procedure, especially for higher myopia. In terms of the postoperative dry eye, SMILE shows a clear advantage over LASIK as numerous studies have shown significant differences about the Schirmer's, Tear film break up time, corneal sensitivity, and corneal nerve regeneration to be better following SMILE compared to LASIK. There is some evidence that since the Bowman's membrane (BM) and the anterior lamellae remain intact after SMILE, this may be a potential advantage for corneal biomechanics over LASIK and PRK where the BM is either severed or ablated, respectively, however, the data on biomechanics are inconclusive at present. Overall, this procedure has proved to be promising, delivering equivalent, or better visual and refractive results to LASIK and providing clear advantage in terms of being a flapless, minimally invasive procedure with minimal pain and postoperative discomfort thus offering high patient satisfaction.

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Section: Principles and Surgical Techniquementioning

confidence: 99%

Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm

Ganesh

Brar

Arra

2018

Indian J Ophthalmol

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Modern technologies of refractive lenticular extraction in the correction of myopia

Mushkova

Костенев

Maychuk

et al. 2022

Rossijskij oftalʹmologičeskij žurnal

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Purpose. To analyze the clinical and functional results of refractive lenticular extraction using ReLEx SMILE® and CLEAR® technologies in patients with moderate and high myopia.Materials and methods. 160 patients (160 eyes) aged 18 to 36 years diagnosed with moderate or high myopia, who had binocular vision, average keratometry parameters (43.0–45.0 D), and no contraindications to laser vision correction were operated according to the technology of refractive extraction of lenticula followed up 1 and 3 months after surgery. The patients were divided into 2 groups: (1) SMILE, which included 80 eyes of patients operated with the femtosecond laser VisuMax 500; and (2) CLEAR, including 80 eyes of patients operated using the femtosecond laser FEMTO LDV Z8. Both types of surgery were performed according to standard protocols.Results. No intraoperative complications were recorded. The analysis of clinical and functional parameters in the correction of myopia using the technology of refractive lenticular extraction performed with VisuMax and LDV Z8 femtosecond lasers demonstrated high and comparable efficiency, safety, predictability and stability.Conclusion. Both technologies of refractive lenticular extraction can be recommended for wide clinical use in the correction of moderate and high myopia.

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Tear Neuromediator and Corneal Denervation Following SMILE

Chin¹,

Lin²,

Lee³

et al. 2021

J Refract Surg

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PURPOSE: To investigate the changes in tear neuromediators and corneal subbasal nerve plexus following small incision lenticule extraction (SMILE) and to study its association with different refractive power of corrections. METHODS: Thirty patients were included for tear neuromediator analysis (40 eyes) and corneal nerve analysis using in vivo confocal microscopy scans (20 eyes). Tear samples were collected preoperatively and 1 week and 1, 3, 6, and 12 months postoperatively and analyzed for the substance P, calcitonin gene-related peptide (CGRP), and nerve growth factor (NGF) concentrations using the enzyme-linked immunosor-bent assay (ELISA). RESULTS: Corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), and corneal nerve branch density (CNBD) decreased significantly postoperatively, then gradually increased from 3 months onward, but did not recover to the baseline levels at 12 months. Tear substance P and CGRP levels remained stable over 12 months. Tear NGF levels demonstrated a small peak at 1 week before decreasing significantly compared to preoperative levels at 6 months ( P = .03) and 12 months ( P = .007). The 1-month reduction in CNFL, tear substance P, and CGRP concentrations were significantly correlated with the corrected spherical equivalent (SE) ( r = 0.71 for CNFL; r = −0.33 to −0.52 at different time points for substance P and CGRP, respectively, all P < .05). Compared to the low to moderate myopia group, the high myopia group (corrected SE greater than −6.00 diopters) had a significantly greater decrease in CNFD, significantly higher tear substance P concentrations at 1 week, 1 month, and 6 months, and significantly higher tear CGRP concentrations at 1 and 6 months. CONCLUSIONS: These results provide new insight into the neurobiological responses and their potential implications in corneal nerve damage and recovery after SMILE. High myopia treatment was associated with greater corneal denervation and neuroinflammation. [ J Refract Surg . 2021;37(8):516–523.]

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Surgical instruments for small incision lenticule extraction (SMILE)

Cited by 4 publications

References 16 publications

Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm

Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm

Modern technologies of refractive lenticular extraction in the correction of myopia

Tear Neuromediator and Corneal Denervation Following SMILE

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