Original Research

Small-incision lenticule extraction for correction of refractive error after 2 years of follow-up

Hassenien S. Shuber, Hussein A. Alhamami, Salah Z. Alasadi
African Vision and Eye Health | Vol 80, No 1 | a596 | DOI: https://doi.org/10.4102/aveh.v80i1.596 | © 2021 hassenien Safa Shuber | This work is licensed under CC Attribution 4.0
Submitted: 10 July 2020 | Published: 24 February 2021

About the author(s)

Hassenien S. Shuber, Department of Surgery, College of Medicine, Mustansiriyah University, Baghdad, Iraq
Hussein A. Alhamami, Department of Surgery, Kufa Medical College, University of Kufa, Najaf, Iraq
Salah Z. Alasadi, Department of Surgery, Basra Medical College, University of Basra, Basra, Iraq


Background: Small-incision lenticule extraction (SMILE) is a relatively novel refractive procedure introduced to correct myopia and myopic astigmatism using femtosecond technology.

Aim: The aim of this study was to prospectively assess the predictability, efficacy and safety of SMILE surgery.

Setting: The study took place in Alyamama Vision Refractive Center, Baghdad, Iraq.

Methods: In this prospective, non-randomised, single-centre clinical study, all patients with myopia or myopic astigmatism underwent the SMILE procedure performed by one surgeon (H.S.S.) with a targeted post-operative refraction of 0 to −0.5 dioptres (D). The procedure was performed using the VisuMax femtosecond platform. Post-operative data, including slit-lamp examination and measurements of uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction, and intraocular pressure (IOP), were recorded.

Results: A total of 141 eyes of 76 patients (51 females and 25 males) were included in the study. The mean preoperative spherical equivalent (SE) (−4.37 D ± 1.65 D) ranged from −2.0 D to −10.25 D after 2 years of follow-up, and the mean post-operative SE (−0.06 D ± 0.18 D) ranged from −0.75 D to 0.63 D. A UCVA of 20/40 or better was noted in 98% of the eyes at the 2-year follow-up. Most of the surgical complications, which were seen in 30 eyes, did not result in permanent visual loss. Corneal abrasion was the most common surgical complication, constituting 10.6% of all complications, followed by adherence of the lenticule to the cap (3.5%).

Conclusion: The SMILE procedure is effective with high safety and efficacy, and its complication rate will probably decrease with improvement in the surgeon experience level and refinement of the laser parameters.


myopia; femto-SMILE; small-incision lenticule extraction; SMILE; astigmatism


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