Visual outcomes and complications of small-incision lenticule extraction: a review

Abstract

Currently, several laser ablation techniques are available for refractive error correction. Among these techniques, photorefractive keratectomy and Laser Assisted in Situ Keratomileusis are the most widely performed. With the advent of femtosecond laser for corneal flap creation, visual outcomes have improved and intraoperative complications have been reduced. Recently, Small-Incision Lenticule Extraction (SMILE) has emerged as a new promising technique for myopia and myopic astigmatism correction. This procedure is a flapless corneal refractive surgery in which an intrastromal refractive lenticule is created and extracted through a small peripheral incision. Several studies have analyzed the visual results and corneal changes after SMILE. Safety, efficacy and predictability seem to be comparable to Laser Assisted in Situ Keratomileusis, but SMILE is not exempt of complications. This article reviews studies on corneal morphological changes, optical quality and visual outcomes following SMILE as well as on complications associated to this technique.