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    PRK enhancement after SMILE favorable after short follow-up


    Why surface ablation?

    Dr. Dirisamer noted that in addition to PRK, the options for treating residual refractive error after myopic SMILE include repeating SMILE or performing thin flap femto-LASIK or a CIRCLE procedure, which involves converting the SMILE cap into a flap.

    “There are no reliable data on repeating SMILE, and re-SMILE is not recommended by the manufacturer,” Dr. Dirisamer said. “With either femto-LASIK or CIRCLE, the patient no longer has the advantage of having a flap-free procedure.

    “PRK has known disadvantages, which include pain and slow visual rehabilitation, which would be even slower for an enhancement than after a primary PRK,” he said. “However, we chose PRK because we thought it would be the easiest to perform.”

    The study included data collected at three laser centers located in Austria and Germany. Dr. Dirisamer noted that of 1,963 eyes that underwent myopic LASIK at these sites, 43 eyes (2.2%) of 31 patients had a PRK re-treatment.

    For the 40 eyes that were included in the analysis, mean MRSE before SMILE was -6.35 D and mean MRSE before PRK was -0.86 D. All SMILE procedures were done with a standard protocol.

    Mean time from SMILE to PRK was about 10 months. PRK was performed using the MEL 80 or MEL 90 excimer laser (Carl Zeiss Meditec) with one of four different ablation profiles: Advanced Ablation Algorithm (Triple-A, 67.5%), Tissue Saving Algorithm (TSA, 20%), topography guided (7.5%), or Aberration Smart Ablation (ASA, 5.0%). MMC 0.02% was applied for 20 to 25 seconds. The PRK target was for plano in all cases.

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