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    Low myopia correction: SMILE versus surface ablation

    Ongoing observational case series is comparing the two corrective techniques


    Initial findings

    When performing the SMILE procedure in our ongoing case series, we made a default lenticule side cut of 15 µm irrespective of dioptric correction, and found that the identification of lenticule surfaces was the same for both high and low corrections. However, in our first few cases, we increased the lenticule side cut to up to 30 µm,  but our preferred method for obtaining a thicker lenticule was to increase the diameter of the lenticule and not the side cut.

    With this approach, we obtain a larger optical zone and better visual quality. We also use a dissector with a semi-sharp spoon-shaped tip (SMILE Double Ended Dissector; Duckworth & Kent) that facilitates the lenticule dissection in every direction, including reverse movements, because of its round shape.

    After completing the procedures, visual recovery was much quicker following SMILE than after SA, with SMILE patients at 0.78 at one day postoperative and SA  patients at 0.32 at 1 day postoperative. The efficacy index after 3 months was 0.91 in SMILE and 0.84 in SA patients (Figure 1).

    The comparison of postoperative UDVA and preoperative CDVA was slightly in favour of SMILE, with UDVA after 3 months being the same or better than preoperative CDVA in 65% of SMILE and 48% of surface ablation patients, respectively (Figure 2). Predictability was slightly better in SMILE as well, with 93% of SMILE patients being within +/- 0.5 D at 3 months and 88% of surface ablation patients being within +/- 0.5 D at 3 months (Figure 3).

    We found that both SMILE and SA for low myopia patients brought a high level of safety, efficacy and predictability with visual outcomes. For SMILE patients, these results were at least as good as with surface ablation, if not better.

    Of note, there is more tissue alteration in SMILE than in SA. However, patients appreciate having more comfort and faster visual recovery after SMILE than following SA. However, it is important that we do not throw away our excimer lasers because SAs are invaluable for corneal dystrophies, recurrent erosion syndrome and thin corneas.

    In conclusion, we use SMILE as the preferred method in all myopic laser corrections and use SA in patients with thin corneas and therapeutic indications.

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