title: Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study.
abstract: OBJECTIVE
  This 6 month prospective multi-centre study evaluated the feasibility of performing myopic femtosecond lenticule extraction (FLEx) through a small incision using the small incision lenticule extraction (SMILE) procedure.
  
  
  METHODS
  Prospective, non-randomised clinical trial. PARTICIPANTS; Ninety-one eyes of 48 patients with myopia with and without astigmatism completed the final 6 month follow-up. The patients' mean age was 35.3 years. Their preoperative mean spherical equivalent (SE) was −4.75±1.56 D.
  
  
  METHODS
  A refractive lenticule of intrastromal corneal tissue was cut utilising a prototype of the Carl Zeiss Meditec AG VisuMax femtosecond laser system. Simultaneously two opposite small ‘pocket’ incisions were created by the laser system. Thereafter, the lenticule was manually dissected with a spatula and removed through one of incisions using modified McPherson forceps.
  
  
  METHODS
  Uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity (BSCVA) after 6 months, objective and manifest refraction as well as slit-lamp examination, side effects and a questionnaire.
  
  
  RESULTS
  Six months postoperatively the mean SE was −0.01 D±0.49 D. Most treated eyes (95.6%) were within ±1.0 D, and 80.2% were within ±0.5 D of intended correction. Of the eyes treated, 83.5% had an UCVA of 1.0 (20/20) or better, 53% remained unchanged, 32.3% gained one line, 3.3% gained two lines of BSCVA, 8.8% lost one line and 1.1% lost ≥2 lines of BSCVA. When answering a standardised questionnaire, 93.3% of patients were satisfied with the results obtained and would undergo the procedure again.
  
  
  CONCLUSIONS
  SMILE is a promising new flapless minimally invasive refractive procedure to correct myopia.
authors.affiliation: Department of Ophthalmology, Philipps University of Marburg, Robert-Koch-Strasse 4, 35037 Marburg, Germany. sekundo@med.uni-marburg.de
authors.forename: Walter
authors.initials: W
authors.lastname: Sekundo
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Kunert
authors.forename: Marcus
authors.initials: M
authors.lastname: Blum
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D054140:Refractive Surgical Procedures / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*