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Klin Monbl Augenheilkd 2020; 237(12): e15-e34
DOI: 10.1055/a-1291-9041
CME-Fortbildung

SMILE – Small Incision Lenticule Extraction

SMILE – Small Incision Lenticule Extraction
Gernot Steinwender
,
Mehdi Shajari
,
Wolfgang J. Mayer
,
Daniel Kook
,
Martin Dirisamer
,
Thomas Kohnen
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Zusammenfassung

Die SMILE (small incision lenticule extraction) zählt zu den Verfahren der refraktiven Lentikel-Extraktion und hat sich im letzten Jahrzehnt zu einem etablierten Bestandteil des modernen refraktivchirurgischen Spektrums entwickelt. Dieser Beitrag gibt einen Überblick über Patientenselektion, Operationsmethode, mögliche Komplikationen und klinische Ergebnisse dieser Methode.

Abstract

Refractive lenticule extraction is a corneal surgical technique that uses a femtosecond laser exclusively to create an intrastromal refractive lenticule for the correction of myopia and myopic astigmatism. In small incision lenticule extraction (SMILE) the generated refractive lenticule is subsequently extracted through a small incision. The reported efficacy, predictability and safety of the flap-less SMILE procedure is similar to those of femtosecond laser in situ keratomileusis (LASIK). Advantages of SMILE over LASIK include less iatrogenic dry eye, fewer induced higher-order aberrations, and potentially less biomechanical weakening of the cornea. However, there is a steeper surgeon learning curve for SMILE as the procedure is technically more challenging than LASIK. Furthermore, the current SMILE laser platform cannot use cyclotorsion control or eye-tracking technology and retreatment options are more complex compared to LASIK. This review looks at patient selection, surgical method, possible complications, retreatment options, and postoperative outcome of the SMILE technique.

Kernaussagen

  • Die SMILE zählt zu den Verfahren der refraktiven Lentikel-Extraktion und wird gegenwärtig zur Myopie- und Astigmatismuskorrektur eingesetzt.

  • Sie bietet eine gute Effektivität und ein hohes Maß an Sicherheit mit klinischen Ergebnissen ähnlich jenen der Femto-LASIK.

  • Der Andockvorgang ist bei dem gänzlich Femtosekundenlaser-basierten Verfahren von großer Bedeutung, da bei diesem Schritt die Zentrierung der Behandlungszone festgelegt wird.

  • Die SMILE erfordert höhere chirurgische Fertigkeiten als die Femto-LASIK und weist eine signifikante Lernkurve auf.

  • Für refraktive Nachkorrekturen bieten sich mehrere Optionen, auch wenn sich noch keine als eindeutiger Standard etablieren konnte.

  • Ein Vorteil der SMILE gegenüber der Femto-LASIK liegt in der geringeren Induktion eines trockenen Auges.

  • Die bei der SMILE im Vergleich zur Femto-LASIK potenziell geringere biomechanische Schwächung der Hornhaut konnte bislang noch nicht in vivo nachgewiesen werden.

Schlüsselwörter

refraktive Chirurgie - SMILE - Operationsmethode - Komplikationen - Ergebnisse

Key words

refractive surgery - SMILE - surgical method - complications - results - refractive lenticule extraction


Publication History

Article published online:
18 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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