Complications of SMILE Surgery - Unveiling the Complexities

Introduction

In addition to LASIK, SMILE Laser surgery has arisen as another alternative for a novel laser method to address nearsightedness. SMILE (short incision lenticule extraction) is a LASIK-like laser vision repair operation. Advancements have been made regularly since the launch and widespread availability of LASIK surgery. A method known as Small Incision Lenticule Extraction, or SMILE, was introduced in 2012. This is a type of refractive surgery that makes use of a Femtosecond Laser. SMILE produces similar results as LASIK but with potential advantages, such as speedier post-op dry eye recovery, reinnervation of corneal nerves, and a possible biomechanical advantage.

What Is the Process of SMILE Laser Surgery?

• While still in its early stages, the SMILE technique is a promising alternative to LASIK.

• Given its flapless process and results similar to LASIK, it may offer the same corrective powers as LASIK with the added benefits of faster post-op dry eye recovery, faster reinnervation of corneal nerves, and biomechanical advantages.

• SMILE laser eye surgery is performed with a VisuMax femtosecond laser, a Carl Zeiss Meditec-established technique.

• The same laser is then used to make a small arc-shaped incision on the cornea's surface, through which the surgeon collects and discards the lenticular—the removal of the tiny lenticular changes the curvature of the cornea, which improves nearsightedness.

• Without stitches, the corneal incision heals quickly, producing more excellent eyesight.

• SMILE cuts and excludes a thin corneal lenticule rather than a thin flap on the cornea. Then, in a minimally invasive operation (Blade-free Vision Correction), it is removed by a tiny incision between two and four mm.

• SMILE laser eye surgery can reduce nearsightedness by up to -10.00 diopters (D).

• Applicants must be at least 22 years old and have astigmatism of no greater than -0.50 D. Also, their eyeglass prescription must be consistent for at least a year.

What Are the Complications of SMILE Surgery?

• The shallow frequency of reported complications during the SMILE operation lends credence to the procedure's purported safety and predictability.

• SMILE studies discovered tiny tears at the incision, perforated caps in a few cases, and epithelial abrasions in others.

• None of these patients, though, experienced delayed visual symptoms. Since SMILE requires more time than a LASIK flap, one of the main complications is the loss of suction during the femtosecond laser component of the treatment.

• Even though they were reported to be extremely rare, a study found that 81.8 percent of cases with suction loss could be reapplied in the same situation. The remaining suction loss cases were terminated; nevertheless, it should be mentioned that a considerable proportion of patients in each issue of suction loss achieved UDVA within the attempted correction.

• Compared to LASIK, there is less corneal nerve severance since only a minor incision (2 to 3 mm) is made instead of a complete flap.

• Studies have demonstrated increased nerve reinnervation following treatment, consistent with a lower incidence of post-operative dry eye. All dry eye metrics were shown to be worse in the early postoperative period for both groups in research by Xu et al. comparing LASIK with SMILE; however, the SMILE group performed better on the Schirmer's test, the McMonnies score, and tear breakup time.

• These results by Xu et al. are consistent with findings from a study by Denoyer et al., which showed that while 80 percent of SMILE patients finished using any eye drops at six months following surgery, just 57 percent of patients in the LASIK group did.

• The study also found that high rates of dry eye symptoms were reported for both procedures one month after surgery.

• A further study that tracked 80 eyes for a year after patients had one look treated with LASIK and the other with SMILE observed a steady improvement in both eyes' visual complaints (halos, glare, etc.) following both procedures.

• Although the danger of ectasia is considered low, it can nevertheless occur in high-risk eyes with SMILE, with an incidence of approximately 0.15 percent.

• Although the risk of ectasia is decreased with SMILE, the majority of reported instances included patients who were considered to be at high or borderline risk for LASIK.

• Similarly, reports of pressure-induced stromal keratitis (PISK), corneal haze, interface infections, diffuse lamellar keratitis (DLK), and epithelial ingrowth have all been made about interface-related problems.

What Are the Laser Eye Surgery Restrictions?

First, LASIK and laser vision correction can significantly reduce astigmatism and farsightedness, but SMILE can only treat nearsightedness. Additionally, SMILE cannot handle higher-order aberrations (HOAs), which can impair night vision, whereas LASIK and PRK can. SMILE may help HOAs in specific ways. Moreover, if one needs further vision correction due to residual refractive error following a SMILE surgery. For optimal outcomes, PRK is usually the recommended augmentation treatment.

Lastly, just like any recent vision correction operation, a surgeon may need to do many SMILE surgeries before fully understanding the surgical approaches necessary to provide the best possible results with the least danger.

How Safe Is SMILE Surgery?

Studies reveal that SMILE corrects nearsightedness almost as well as LASIK, but without requiring the creation of a corneal flap akin to LASIK. Additionally, SMILE carries a lower risk of dry eye complaints than LASIK. This could be due to several factors, one being that SMILE affects fewer corneal nerves because surgery is performed inside the cornea rather than requiring a substantial corneal flap. In addition, the cornea may be more biomechanically stable after SMILE because of the minimal incision than it would be after LASIK in terms of shape retention (particularly after damage). The likelihood of requiring a further procedure for myopia correction following SMILE is lower. It is conceivable since the SMILE technique causes reduced corneal dryness.

Conclusion

In some circumstances, the SMILE surgery is an attractive option for LASIK. Given its flapless technique and results comparable to LASIK, it may provide the same correctional abilities with the potential benefits of faster post-op dry eye recovery, faster reinnervation of corneal nerves, and biomechanical advantages. Because of its minimally invasive technique and good outcomes, this therapy may become an option for more patients undergoing refractive surgery shortly.