SMILE PROCEDURE IN PATIENT WITH AMBLYOPIA REFRACTIVE: DO OR DON’T?

Excimer (excited dimer) laser photoablation can be used to remove corneal tissue withsubmicron accuracy, without thermal build up or adjacent tissue damage. Myopia can becorrected by removing tissue from the central cornea resulting in central flattening and reducedrefractive power. Femtosecond lasers emit light pulses of short duration (10–15s) at 1053 nmwavelength that cause photodisruption of the tissue with minimum collateral damage. Thisenables bladeless incisions to be performed within the tissue at various patterns and depth withhigh precision, safety and repeatability. Femtosecond laser can be used for many anteriorrefractive procedures; LASIK flap creation, SMILE, corneal graft surgery, astigmatickeratectomy, and channel cutting for insertion of intracorneal ring segments.1Small Incision Lenticule Extraction or known as SMILE is a corneal based refractive surgeryprocedure. SMILE is a femtosecond-only procedure that removes stromal tissue (the lenticule)without a flap. The femtosecond laser creates the posterior surface, vertical sides and anteriorsurface of the lenticule, and a small tunnel for extraction of the lenticule. The cap thickness(above the lenticule) is typically 100–120 μm. The lenticule thickness depends on the refractiveerror. SMILE shows excellent efficacy, safety, predictability, and avoids flap-relatedcomplications. There is reduced damage to Bowman’s layer with better biomechanical integrityand corneal stability. The basal nerve plexus is minimally disrupted, reducing dry eye andpatient discomfort.