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Something to SMILE about. Is small incision lenticule extraction ready to become the gold standard in laser refractive surgery? Yes

Eye volume 38, pages 636–638 (2024)Cite this article

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Millions of laser in situ keratomileusis (LASIK) procedures have been performed for over 30 years with consistent and impressive results, making LASIK one of the most successful surgeries and the refractive procedure of choice for millions of patients [1]. Although LASIK has led to the improvement of vision and quality of life [2] of millions of patients, this ‘ride’ has not been without problems and bumps along the way. Symptoms and sequelae associated with dry eye and the possibility of corneal ectasia have been reduced with the help of advanced technology for screening (such as Pentacam) [3]; although reduced, these risks remain [4].

Since this lack of flap creation and further ablation by the excimer laser does not disturb the epithelium, Bowman layer and anterior stroma, SMILE does not cause the structural weakening associated with LASIK and hence has a reduced risk of post-operative ectasia a dreaded complication of LASIK especially in higher corrections. SMILE has mainly, but not solely, been used in mild myopia; in fact, SMILE has received FDA approval for myopic corrections of ≤–10.00 D with or without astigmatism ≤–5.00 D. Studies with mid to long-term results on low and high myopic corrections are slowly emerging [7].

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Fig. 1: Surgical steps of SMILE.

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Authors and Affiliations

  1. 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

    M. Tsatsos, I. Tsinopoulos & N. Ziakas

  2. Corneal Department, Dr Agarwal’s Hospital, Chennai, India

    I. Giachos & S. Jacob

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  1. M. Tsatsos
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  2. I. Giachos
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  4. N. Ziakas
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  5. S. Jacob
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Contributions

MT: original idea, data collection, reference check, review of the manuscript. IG: data collection, reference check, review of the manuscript. IT: reference check and review of the manuscript. NZ: reference check and review of the manuscript. SJ: image editing and review of the manuscript.

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Correspondence to M. Tsatsos.

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Tsatsos, M., Giachos, I., Tsinopoulos, I. et al. Something to SMILE about. Is small incision lenticule extraction ready to become the gold standard in laser refractive surgery? Yes. Eye 38, 636–638 (2024). https://doi.org/10.1038/s41433-023-02745-z

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