Preliminary Evidence of Successful Enhancement After a Primary SMILE Procedure With the Sub-Cap-Lenticule-Extraction Technique

Donate, David; Thaëron, Rozenn

doi:10.3928/1081597x-20150928-04

Cited by 37 publications

(21 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this scenario, another option would be to perform a sub-cap-lenticule-extraction, in which the interface of the primary SMILE procedure becomes the superior plane of the new lenticule and the FSL cuts only the inferior plane and the side cut of the new lenticule. This would create another lenticule posterior to the previous one [35]. …”

Section: Discussionmentioning

confidence: 99%

Retreatment strategies following Small Incision Lenticule Extraction (SMILE): In vivo tissue responses

et al. 2017

View full text Add to dashboard Cite

With any refractive correction, including Small Incision Lenticule Extraction (SMILE), there may be a residual refractive error that requires a retreatment. Here, we investigated the tissue responses following various retreatment procedures in a rabbit model of SMILE. All rabbits underwent a -6.00D correction with SMILE. Two weeks later, they underwent -1.00D enhancement by: (i) VisuMax Circle, followed by excimer ablation (S+C); (ii) secondary SMILE anterior to the primary procedure (S+SE); or (iii) surface ablation (S+P), and were examined for 28 days. S+P induced corneal edema and haze, and more CD11b- (23±6 cells) and TUNEL-positive (36±4 cells) cells in the central stromal superficial layers early post-operatively (p<0.001 compared to other procedures). The corneas appeared normal on day 28 after S+P, but had a lower number of keratocytes near the laser ablated plane compared to other procedures. S+SE and S+C did not induce corneal haze and resulted similar level of fibronectin. However, S+C resulted in more inflammatory (10±2 cells; p = 0.001) and apoptotic cells (25±2 cells; p<0.001) compared to S+SE (7±1 inflammatory cells and 21±3 apoptotic cells) early post-operatively. In conclusion, each SMILE retreatment method resulted in unique tissue responses. S+SE offers advantages, such as minimal inflammation and cell death, as well as maintaining a ‘flap-less’ surgery, over other procedures. However, depending on the degree of enhancement, the lenticule may become too thin to be extracted and the procedure becomes more difficult to perform than S+C and S+P. S+P can maintain corneal integrity by avoiding flap creation and is technically more simple to perform than the others, but the surgery needs to be supplemented with mitomycin-C in order to reduce inflammation and modulate better wound healing.

show abstract

Section: Discussionmentioning

confidence: 99%

Retreatment strategies following Small Incision Lenticule Extraction (SMILE): In vivo tissue responses

et al. 2017

View full text Add to dashboard Cite

show abstract

“…[ 11 ] Recently, Donate and Thaëron showed the feasibility of performing another SMILE procedure below the existing interface. [ 72 ]…”

Section: Retreatment Optionsmentioning

confidence: 99%

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

Ganesh

Brar

Arra

2018

Indian J Ophthalmol

View full text Add to dashboard Cite

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.

show abstract

“…Dieser Ansatz wird in der Literatur auch als "subcap SMILE" bezeichnet. Sie wurde erstmalig von David Donate (Lyon) auf der ESCRS 2015 vorgestellt [11]. Hier wird mit dem Femtosekundenlaser VisuMax ® (Carl Zeiss Meditec AG, Jena) ausschließlich ein 2. refraktiver Schnitt sowie ein Lentikel-Sidecut präpariert, während man die ursprüngliche Inzision und das Cap-Interface der ursprünglichen SMILE erneut nutzt (▶ Abb.…”

Section: Capless Smile: Smile Nach Smile (Off-label)unclassified

SMILE: Techniken und Ergebnisse von Nachoperationen

Meyer¹,

Kunert

2017

Klin Monatsbl Augenheilkd

View full text Add to dashboard Cite

With a rate of less than 2 %, retreatment after SMILE is rare. If a touch-up is required, there are different options to choose from: surface ablation (PRK/LASEK) with Mitomycin C, the standard femto-flap procedure with the same parameters, the CIRCLE procedure, which extends the previous SMILE interface into a flap, or the innovative but off-label capless SMILE procedure, which preserves all the advantages of SMILE.

show abstract

Preliminary Evidence of Successful Enhancement After a Primary SMILE Procedure With the Sub-Cap-Lenticule-Extraction Technique

Abstract: This first case report demonstrates the feasibility of an enhancement with the SubCap-LE procedure after a primary SMILE procedure. More cases are needed to develop a consistent surgical protocol.

Cited by 37 publications

References 10 publications

Retreatment strategies following Small Incision Lenticule Extraction (SMILE): In vivo tissue responses

Retreatment strategies following Small Incision Lenticule Extraction (SMILE): In vivo tissue responses

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

SMILE: Techniken und Ergebnisse von Nachoperationen

Contact Info

Product

Resources

About