Circle And Femto-Lasik For Enhancement After Relex-Smile

Different approaches have been published for refractive enhancement after RELEX-SMILE. Whereas PRK has the disadvantage of long visual recovery time, patients receiving Circle or Femto-LASIK benefit from quick visual recovery. Femto-LASIK on SMILE can be performed with any femto-laser, whereas Circle on SMILE can only be performed with the Visumax (Zeiss)  software, which is not always readily available.

Sehzentrum for Eyelaser & Eye Suergy Graz, Austria

Patients after Smile undergoing Circle or Femto-LASIK enhancement are compared in terms of visual acuity and complications. 33 out of 2431 eyes undergoing RELEX-SMILE needed enhancement for the correction of a remaining refractive error. 23 eyes were treated with circle and 10 eyes were enahced with Femto-LASIK. The mean enhancement parameters for circle were -0,63 ± 0,5 D in sphere and 0,74 ± 0,63 D in cylinder. The mean enhancement parameters for Femto-LASIK were -1,25 ± -0,27 D in sphere and -0,38 ± -0,22 D in cylinder. The mean cap thickness was 126±5 µm and 126± 2 µm for eyes undergoing Circle and Femto-LASIK respectively. Flap thickness was chosen between 95 to 100 µm, based on the previous cap thickness.

For the Circle enhancement, the Unaided Distance Visual Acuity (UDVA) increased from +0,22 ± 0,1 logMAR to -0,1 logMAR in all eyes. None of the eyes lost a line of BCVA. UDVA increased from + 0,27 to -0,1 logMAR in nine out of ten eyes after Femto-LASIK intervention, whereas the one eye developed a cryptic buttonhole after Femto-LASIK and the operation was subsequently aborted.

Circle and Femto-LASIK are both good approaches for enhancement after SMILE with similar success rates in terms of correction of the refractive error.  Femto-LASIK has the advantage that the enhancement can be performed with any femto-laser and is independent from special software. The only limitation for Femto-LASIK on SMILE is a cap thickness of at least 125 µm.