2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 12: Emerging Technologies
Refractive Lenticule Extraction
Studies have reported a low incidence of complications related to SMILE. Because the procedure can be technically challenging, most of the complications described in the literature occurred early in the learning curve. In a study enrolling 1800 eyes treated with SMILE, perioperative complications included epithelial abrasions (occurring in 6.0% of eyes), difficult lenticule extraction (1.9%), small tears at the incision (1.8%), and cap perforation (0.22%); a major tear occurred in 1 eye (0.06%). However, none of these patients reported late visual symptoms. Postoperative complications included trace haze (8.0%), epithelial dryness on postoperative day 1 (5.0%), interface inflammation secondary to central abrasion (0.3%), and minor interface infiltrates (0.3%). Topographic irregular astigmatism was described in 1.0% of eyes, resulting in reduced 3-month best-corrected visual acuity (BCVA; also called corrected distance visual acuity, CDVA), or ghost images. Another complication unique to SMILE is the presence of a lenticule remnant in the interface. Postoperative ectasia has also been reported.
Dong Z, Zhou X. Irregular astigmatism after femtosecond laser refractive lenticule extraction. J Cataract Refract Surg. 2013;39(6):952–954.
Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology. 2014;121(4):822–828.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.