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    Touch-up techniques following SMILE

    Surgeons need to be aware of the options for enhancement




    Photorefractive keratectomy (PRK) is well known and easy to perform. From a surgical point of view, PRK after SMILE is the same.

    The surgeon starts by removing the epithelium, applying the laser energy and placing a sponge with mitomycin C on the eye for 30 seconds to 2 minutes. The surgeon will rinse the eye and then put on the contact lens.

    It is important to note that during PRK after SMILE, the surgeon should use mitomycin C because, otherwise, there can be complications with haze formation postoperatively. Also, the surgeon should keep the optical zone the same as in the SMILE procedure without making it larger or smaller.

    My colleagues and I have also found that the aspheric profile from the excimer laser tends to overcorrect in low corrections, and as a result we do not use a fixed aspheric correction as a touch-up procedure. We have found that tissue-saving profiles and topographic guided profiles work well and we did not find any statistically significant differences among them. As with traditional PRK, note that the downsides of PRK are pain and slow visual rehabilitation.

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