Cap-preserving SMILE Enhancement Surgery

Abstract

Abstract Background Different enhancement procedures have been suggested for reduction of residual refractive errors after SMILE. The aim of this study is to evaluate an improved cap-preserving technique for enhancement after SMILE (Re-SMILE). Methods A retrospective case series was conducted at Eye subspecialty center, Cairo, Egypt on 9 eyes with myopia or myopic astigmatism (spherical equivalent – 8.0 and − 12.0D). undergoing SMILE procedure and needed second interference. This was either because the more myopic meridian was more than − 10.0 D and therefore planned to have two-steps procedure (six eyes) or because of under correction needing enhancement (three eyes). Assessment after the primary SMILE procedure was conducted at 1 day, 1 week, 1 month and 3 months postoperatively. Assessment after Re-SMILE was conducted at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. The assessments included full ophthalmic examination, objective and subjective refraction, and rotating Scheimpflug camera imaging. Results Preoperatively, the mean refractive spherical equivalent (MRSE) values were: − 9.36 ± 0. 89. After primary SMILE it was − 2.18 ± 0.71. After Re-SMILE it was − 0.13 ± 0.68. MRSE was significantly improved after both procedures (P < 0.01). The safety index of primary SMILE cases was 1.65 ± 0.62 and for Re-SMILE 1.13 ± 0.34 and the efficacy index was 1.14 ± 0.24 after primary SMILE and 1.11 ± 0.26 after Re-SMILE. Conclusion Centered cap-preserving Re-SMILE is an effective procedure in reducing residual refractive errors after primary SMILE in high myopes.

Keywords

• SMILE
• SMILE enhancement
• Cap-preserving SMILE enhancement
• Re-SMILE