Published 16 pieces of SCI papers about ReLEx SMILE
THE SURGEON'S GUIDE TO SMILE Small Incision Lenticule Extraction. INCLUDES Video Website Access. Dan Z. Reinstein • Timothy J. Archer • Glenn I. Carp. SLACK Incorporated
ReLEx SMILE (Small Incision Lenticule Extraction) involves using a femtosecond laser to create a corneal lenticule which is extracted whole through a small incision. Standard LASIK involives the cutting of a corneal flap. In ReLEx SMILE, however, an incision 10 times smaller than the LASIK corneal flap is made which can not only minimize corneal damage and reduce dry eyes, but is also studier to external shock.
Step Description
A refractive lenticule and small incision are created inside the intact cornea.
The lenticule is removed through the incision with only minimal disruption to the corneal biomechanics
Removing the lenticule changes the shape of the cornea, thereby achieving the desired refractive correction.
Accurate Centration for the Prevention of Blurred Vision
An accurate centration is directly linked to the safety and the outcome of the laser surgery. EYEREUM uses SCOUT to measure the cornea shape and the accurate corneal offset in order to perform a safe surgery. With the results of various preliminary examinations, your private surgeon can determine the offset of the lenticule.
Reducing the margin of error in finding the offset leads to a clear and sharp vision and this depends on the expertise and experience of your surgeon.
SMILE Preserves the Corneal Stiffness
ReLEx SMILE doesn’t ablate any corneal tissue like the standard LASIK, but instead breaks the molecular bonds in the cornea without causing any collateral damage, thus the corneal stiffness is preserved. However, the corneal volume before surgery and the volume of the lenticule being removed have to be thoroughly checked beforehand. This allows your specialist to design a complete tailored surgery in order to minimize the loss of corneal stiffness and prevent keratoconus.
LASIK
Percentage of Residual Stromal Depth (%)
Percentage of Maximum Tensile Strength (%)
Zone
100 to 90
100 to ~88
Flap (Anterior)
90 to 70
~88 to ~63
Ablation
70 to 0
~63 to ~10
Residual Stromal Bed (Posterior)
The chart illustrates the relationship between the Percentage of Residual Stromal Depth (%) on the x-axis and the Percentage of Maximum Tensile Strength (%) on the y-axis for LASIK procedures. The x-axis scale runs from 100% (Anterior) to 0% (Posterior). The data is divided into three distinct zones: Flap, Ablation, and Residual Stromal Bed.
SMILE
Percentage of Residual Stromal Depth (%)
Percentage of Maximum Tensile Strength (%)
Stroma Section
100
100
Anterior Residual Stroma
90
~90
Anterior Residual Stroma
80
~75
Anterior Residual Stroma
70
~65
Lenticule
60
~55
Lenticule
50
~50
Posterior Residual Stroma
40
~48
Posterior Residual Stroma
30
~45
Posterior Residual Stroma
20
~40
Posterior Residual Stroma
10
~25
Posterior Residual Stroma
0
~10
Posterior Residual Stroma
Y-axis
Percentage of Maximum Tensile Strength (%)
X-axis
Percentage of Residual Stromal Depth (%)
Left Region
Anterior
Right Region
Posterior
Stroma Layers
Anterior Residual Stroma
Lenticule
Posterior Residual Stroma
▲ The relationship between the removed cornea and the corneal stiffness during LASIK SMILE / From a thesis written by Dr. Dan Reinstein
As ReLEx Smile creates a 2 mm corneal micro-tunnel through which the lenticule is extracted. This causes less disturbance to the corneal nerves and induces less dry-eyes than LASIK.
▲ SMILE Cuts fewer anterior nerves
Mean Corneal Sensation (mm) by Time Point (Months)
Procedure
Pre-op (~0)
Post-op (~0.1)
0.25 Months
1 Month
3 Months
6 Months
12 Months
LASIK (16 studies)
~53
~6
~13
~20
~30
~42
~50
SMILE (7 studies)
~56
~32
~39
~43
~49
~53
~55
Y-axis
Mean Corneal Sensation (mm)
X-axis
Time Point (Months)
Non-Invasive Tear Film Breakup Time
Procedure
Pre-operative (Estimated)
Post-operative (Estimated)
LASIK
~9.2
~6.1
SMILE
~9.3
~9.0
▲ SMILE induces less dry-eye than LASIK. Dan Z Reinstein - smile history, fundametals of a new refractive surgery technic and clinical outcomes.
ReLEx Smile, however, isn’t safe for everyone. EYEREUM will guide you through some evaluations to test for both quantitative (refraction) and qualitative (quality of vision) functions to see if you are eligible for ReLEx Smile. EYEREUM usually recommends SMILE to those with the following conditions.
01Corneal thickness : more than 500㎛
02A normal shaped anterior/front and posterior/back cornea
03Dry-eye test (Schirmer test) : less than 5 mm
04Having only one day to recover
05Corneal offset: less than 250㎛
However, ReLEx SMILE maybe restricted to those with myopia greater than -5D and astigmatism greater than 10D.
The Chief Director of EYEREUM, Dr. David Kang(David Sung Yong Kang) was appointed International Speaker from the world leading Zeiss German headquarters for his extraordinary medical techniques and skills. Dr. David Kang(David Sung Yong Kang) is still working together with Zeiss in the study of HOA occurring after having undergone SMILE and has presented these studies in several international conferences sponsored by ZEISS.
Debacles
Schwind User EYEREUM E David S
GRAND HYATT DUBAI
ASCRS AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY
