One-year refractive results, contrast sensitivity, high-order aberrations and complications after myopic small-incision lenticule extraction (ReLEx SMILE)

  • Walter SekundoEmail author
  • Jana Gertnere
  • Thomas Bertelmann
  • Igor Solomatin
Refractive Surgery



To report one year results of the first cohort of routine refractive lenticule extraction through a small incision (ReLEx SMILE) for correction of myopia and myopic astigmatism.


Fifty-four eyes of 27 patients with spherical equivalent of −4.68 ± 1.29D who underwent routine ReLEx SMILE by a single surgeon were prospectively followed-up for 1 year. We used the VisuMax® femtosecond laser system (Carl Zeiss Meditec AG, Germany) with a 500 kHz repetition rate. Folow-up intervals were at 1 day, 1 week, 1, 3, 6, and 12 months after surgery. We obtained following parameters: uncorrected (UDVA) and distance-corrected visual acuity (CDVA), contrast sensitivity, and wave front measurements. We also recorded all complications.


Because of suction loss in one eye, 12-month results were obtained in 53 eyes as follows. After 1 year, 88 % of eyes with plano target had an UDVA of 20/20 or better. Twelve percent of eyes lost 1 line of CDVA, while 31 % gained 1 line and 3 % gained 2 lines. The mean SE after 1 year was −0.19 ± 0.19. The mean refraction change between month 1 and 12 was 0.08 D. Neither mesopic nor photopic contrast sensitivity showed any significant changes. The high-order aberrations (HOA) increased from 0.17 to 0.27 μm (Malacara notation). No visually threatening complications were observed.


In this first cohort, ReLEx® SMILE produced satisfactory refractive outcomes with moderate induction of HOA and unaffected contrast sensitivity after 1 year.


ReLEx SMILE Small-incision lenticule extraction Contrast sensitivity High-order aberrations Complications 


  1. 1.
    Arbelaez MC, Aslanides IM, Barraquer C, Carones F, Feuermannova A, Neuhann T, Rozsival P (2010) LASIK for myopia and astigmatism using the SCHWIND AMARIS excimer laser: an international multicenter trial. J Refract Surg 26:88–98PubMedCrossRefGoogle Scholar
  2. 2.
    Blum M, Kunert K, Schröder M, Sekundo W (2010) Femtosecond lenticule extraction for the correction of myopia: preliminary 6-month results. Graefes Arch Clin Exp Ophthalmol 248:1019–1027PubMedCrossRefGoogle Scholar
  3. 3.
    Gertnere J, Solomatin I, Sekundo W (2013) Refractive lenticule extraction (ReLEx flex) and wavefront-optimized Femto-LASIK: comparison of contrast sensitivity and high-order aberrations at 1 year. Graefes Arch Clin Exp Ophthalmol 251:1437–1442PubMedCrossRefGoogle Scholar
  4. 4.
    Hjortdal JØ, Vestergaard AH, Ivarsen A, Ragunathan S, Asp S (2012) Predictors for the outcome of small-incision lenticule extraction for Myopia. J Refract Surg 28:865–871PubMedCrossRefGoogle Scholar
  5. 5.
    Reinstein DZ, Archer TJ, Randleman JB (2013) Mathematical model to compare the relative tensile strength of the cornea after PRK, LASIK, and small incision lenticule extraction. J Refract Surg 29:454–460PubMedCrossRefGoogle Scholar
  6. 6.
    Riau AK, Angunawela RI, Chaurasia SS, Lee WS, Tan DT, Mehta JS (2011) Early corneal wound healing and inflammatory responses following refractive lenticule extraction (ReLEx). Invest Ophthalmol Vis Sci 52:6213–6221PubMedCrossRefGoogle Scholar
  7. 7.
    Sekundo W, Kunert K, Russmann C, Gille A, Bissmann W, Stobrawa G, Sticker M, Bischoff M, Blum M (2008) First efficacy and safety study of femtosecond lenticule extraction for the correction of myopia. J Cataract Refract Surg 34:1513PubMedCrossRefGoogle Scholar
  8. 8.
    Sekundo W, Kunert KS, Blum M (2011) Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol 95:335–339PubMedCrossRefGoogle Scholar
  9. 9.
    Shah R, Shah S, Sengupta S (2011) Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg 37:127–137PubMedCrossRefGoogle Scholar
  10. 10.
    Wang Y, Wei S (2013) Comparison of corneal sensitivity between fs-lasik and femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx smile) for myopic eyes. Graefes Arch Clin Exp Ophthalmol 251:1645–1654PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Walter Sekundo
    • 1
  • Jana Gertnere
    • 2
  • Thomas Bertelmann
    • 1
  • Igor Solomatin
    • 2
  1. 1.Department of OphthalmologyPhilipps University of MarburgMarburgGermany
  2. 2.Prof. Solomatin’s Eye ClinicRigaLatvia

Personalised recommendations