Abstract

P 238

Small incision femtosecond lenticule extraction (SMILE) in myopia and myopic astigmatism: results of a prospective multicenter study

Walter Sekundo1, Marcus Blum2
1Klinik für Augenheilkunde, Standort Marburg, Universitätsklinikum Gießen und Marburg GmbH, Marburg, 2Augenklinik, Helios Klinikum Erfurt, Erfurt

Objective
Femtosecond-lenticule extraction is a novel corneal refractive technique (FLEx) where a lenticule of stromal corneal tissue is removed after a flap has been opened. In the present study this technique was further modified and the lenticule extracted through a 80° incision.
Methods
91 eyes of 48 patients with myopia and myopic astigmatism with a spherical equivalent (SEQ) of -4.75 D ± 1.56 D were treated. The follow-up visits were scheduled on day 1, week 1 and month 1, 3 and 6. All surgeries were performed using VisuMax-femtosecond laser, Carl Zeiss Meditec AG, Jena, Germany.
Results
Predictability: At the 6 months follow-up 95% of eyes treated were within bei ± 1.0 D and 79% within ± 0,5 D of intended correction. Stability: SEQ after 1 months = -0,01 D and after 6 months = +0,01 D. The UCVA of ≥20/20 achieved 83% of the eyes treated. However, the cylinder correction of 1 D cyl, showed under correction. Safety: In 53.3% no change in BSCVA, in 32.3% gain of 1 Snellen line and in 3.3% 2 lines. 8.8% lost 1 line; 1.1% 2 lines und 1.1% 3 lines of BSCVA respectively. There was no significant increase in HOA. Following complications were reported: perforation of the upper lamella 1 case, non-progressive epithelial ingrowth 1 case, tear at incision edge in 3 eyes, epithelial defects at incision edge 3 cases and 1 eye with incomplete opening of the incision.
Conclusions
The refractive results of SMILE were superior to those published in the first FLEx papers. However, the astigmatism correction was inferior when compared with the flap-based FLEx. This might be explained by a better stability of the treated cornea, when no flap is created. These first results of the small incision FLEx, called SMILE are very promising, as the results are highly comparable to the state-of-the-art excimer based laser refractive surgery.

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