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SMILE with corneal cross-linking in eyes at risk for ectasia

Cheryl Guttman Krader

Posted: Monday, May 18, 2020


Sung Min Kim, MD

Small Incision Lenticule Extraction with accelerated corneal cross-linking (SMILE Xtra) is a safe, effective, and predictable procedure for refractive correction in eyes at moderate risk for ectasia after corneal refractive surgery, according to the findings of a study reported by Sung Min Kim, MD at the ASCRS Virtual Annual Meeting 2020.
The investigation included 130 eyes of 65 patients that had a cumulative score of 3 on the Randleman Ectasia Risk Score System. All eyes were operated on at the NUNEMISO Eye Center, Seoul, Republic of Korea, and had data from 2 years of follow-up.
Results were analysed for the total cohort and for four subgroups representing eyes with abnormal topography (n = 36), low residual bed thickness (<300 microns; n = 44), high refractive error (spherical equivalent >-9.5 D or lenticule thickness >130 µm; n = 21), and thin preoperative central corneal thickness (<510µm; n = 29).
The functional and refractive results were stable during long-term follow-up. At 2 years, the efficacy index was 1.13, the safety index was 1.16, mean decimal UCVA was 1.12, and spherical equivalent was ±0.5 D in 97.7% of eyes.
Visual recovery and refractive change over 2 years were similar among the four subgroups. Except for day 1 uncorrected visual acuity, the visual outcome was comparable to that of a historical control group that underwent SMILE at the same centre.
“Results of this study show that the safety and predictability of SMILE are not affected by combined crosslinking,” said Dr Kim.
“Thus, SMILE XTRA may be an effective and safe strategy for moderate risk patients.”