Official ESCRS | European Society of Cataract & Refractive Surgeons
Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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CIRCLE enhancement after myopic small incision lenticule extraction (SMILE)

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Session Details

Session Title: SMILE

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 17:36

Venue: Room A3, Podium 2

First Author: : J.Siedlecki GERMANY

Co Author(s): :    N. Luft   W. Mayer   D. Kook   B. Meyer   S. Priglinger   M. Dirisamer     

Abstract Details


To report the outcomes of enhancement after SMILE using the VisuMax CIRCLE option, which converts the SMILE cap into a femtosecond LASIK flap for secondary excimer laser application.


SMILE EYES Clinics Munich and Cologne (Germany) and Linz (Austria)


Twenty-two eyes with a follow up of three months after CIRCLE were included in the analysis. SMILE was performed for a spherical equivalent of -5.56 ± 2.22 Diopters (D) in the usual manner. For retreatment, the CIRCLE procedure was performed after a mean of 10.0 ± 7.9 months for a residual ametropia of -0.51 ± 1.08 D. Flaps were created using pattern D on the VisuMax system, followed by subsequent excimer laser ablation with a Zeiss MEL 90 with plano target in all cases.


CIRCLE allowed for safe flap lifting in all eyes, resulting in a final MRSE of 0.18 ± 0.31 D at three months (p<0.008). The number of eyes within 0.5 and 1.0 D from plano increased from 31.8 % to 90.9 % and from 77.3 % to 100.0 %, respectively. Mean UDVA had already improved from 0.37 ± 0.16 to 0.08 ± 0.16 logMAR at one week (p<0.0001), resulting in 0.03 ± 0.07 logMAR at three months (p<0.0001). CDVA remained unchanged at all time points (pre/post-CIRCLE p=0.40). Two eyes (9.1 %) lost one line of CDVA (safety/efficacy index: 1.03 and 0.97).


The CIRCLE procedure represents an effective retreatment option after SMILE. Compared to surface ablation retreatment after SMILE, CIRCLE seems to offer advantages in respect to speed of visual recovery, safety and predictability - at the price of flap creation.

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