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How Is Enhancement Performed After SMILE?

2 min read

SMILE (Small Incision Lenticule Extraction) does not create a traditional LASIK flap, which influences enhancement options.

When residual refractive error occurs after SMILE, three strategies may be considered:

  • Surface ablation (PRK)
  • Creating a thin LASIK flap above the SMILE cap
  • Cap-to-flap conversion techniques in selected cases

Long-term studies of SMILE demonstrate high refractive predictability overall, but retreatment rates increase in higher myopia groups¹. When LASIK is used as an enhancement technique after SMILE, two stromal interfaces exist:

  • The original SMILE cap interface
  • The new LASIK flap interface

This dual-plane architecture is biomechanically relevant and must be considered when planning retreatment.

Surface ablation avoids creating a second interface but requires epithelial healing and carries small risk of haze, mitigated by mitomycin C².

Published analyses show enhancement after SMILE is safe and effective when conservative stromal bed thresholds are respected³.

Enhancement planning therefore begins at primary procedure selection. Higher myopes (>–5.00 D), who demonstrate higher regression likelihood, may require strategic consideration of initial procedure choice.

SMILE remains predictable. Enhancement is simply more technically nuanced.

References

  1. Vestergaard A, Ivarsen A, Asp S, Hjortdal J. Small-incision lenticule extraction for moderate to high myopia. J Cataract Refract Surg. 2012;38(11):2003-2010.
  2. Carones F, Vigo L, Scandola E, Vacchini L. Mitomycin C to prevent haze after PRK. J Cataract Refract Surg. 2002;28(12):2088-2095.
  3. Reinstein DZ, Carp GI, Archer TJ, Gobbe M. Small incision lenticule extraction outcomes. J Refract Surg. 2014;30(10):680-692.

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About Blue Fin Vision®

Blue Fin Vision® is a GMC-registered, consultant-led ophthalmology clinic with CQC-regulated facilities across London, Hertfordshire, and Essex. Patient outcomes are independently audited by the National Ophthalmology Database, confirming exceptionally low complication rates.