1. Visual and Refractive Outcomes of Small-Incision Lenticule Extraction Performed by Cornea Fellows Victor Boullosa, MD, Erick Hernandez-Bogantes, MD, Arturo Ramirez-Miranda, MD, Alejandro Navas MD, MSc, Enrique O. Graue Hernandez, MD, MSc Department of Cornea and Refractive Surgery, Instituto de Oftalmologia Fundacion Conde de Valenciana, México D.F, México World Cornea Congress, San Diego, CA April, 2015

2. Financial Disclosures Arturo Ramirez-Miranda, MD: Carl Zeiss Meditec: C,S,L Alejandro Navas, MD, MSc: Alcon Laboratories, Inc: L, Carl Zeiss Meditec: C, STAAR Surgical: L Erick Hernandez-Bogantes, MD: None Enrique O. Graue Hernandez, MD, MSc: None Víctor M. Boullosa-Graña, MD: None

3. Introduction Small incision lenticule extraction (SMILE) consists in forming an intrastromal lenticule with a femtosecond laser (VISUMAX, Carl Zeiss Meditec) followed by physical removal through a small incision. Sekundo et al. (1) in a prospective study documented complications up to 10%, all of which 1.1% caused loss of vision.

4. : Some of the surgical challenges that a resident/surgeon in training, must overpass during SMILE are the following: 1.Finding the first dissection plane over the roof of the lenticule. 2.Finding the bottom of the lenticule. 3.When the spatula undermines the lenticule first getting to its base, the lenticule could stick to the superior corneal layers becoming almost invisible. 4.Achieving a complete removal of the lenticule through a small incision wihout disruption of its architecture. Introduction

5. . To report the visual, stability and safety outcomes of SMILE performed by cornea fellows. Purpose ReLEx Anatomy

6. Methods A retrospective, observational study of patients which were consecutively treated with SMILE executed by cornea fellows under supervision from March 2012 to December 2014 was performed. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), mean keratometry, sphere, cylinder and complications were analyzed.

7. Results Our study enrolled total of 150 eyes (86 patients) with a mean follow-up of 5.5±3.8 months (range of 0.1-24 months) The mean age was 27±5.2 years old (23 males, 64 females) ParameterValue (D) PreopPosop Spherical Equivalent-6.11 ± 2.230.23 ± 0.39 Mean keratometry43.9 ± 1.2639.0 ± 5.55 Sphere-5.08 ± 2.120.40 ± 0.93 Cylinder-2.05 ± 1.41-0.70 ± 0.88

8. Stability Efficacy

9. Complications Epithelial defect7.3% Transient edema5.3% Superficial corneal punctate2.6% Loss of suction0.83% Blood cells in interface0.83% Subconjunctival hemorrhage0.83% Corneal perforation0.83% No extraction of lenticule0.83% Results

10. Conclusion Visual and refractive results after SMILE performed by cornea fellows are effective, safe and predictable. Although SMILE is a recent refractive approach, it is suitable to introduce this technique to surgeons in training.

11. 1.Sekundo W, Kunert KS, Blum M. 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. 2011 Mar;95(3):335-9. 2.Vestergaard A, Ivarsen AR, Asp S, Hjortdal J. Small-incision lenticule extraction for moderate to high myopia: Predictability, safety, and patient satisfaction.J Cataract Refract Surg. 2012 Nov;38(11):2003-10. 3.Shah R, Shah S, Senguota S. Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg. 2011 Jan;37(1):127-37. 4.Reinstein DZ, Archer TJ, Gobbe M.Accuracy and reproducibility of cap thickness in small incision lenticule. J Refract Surg. 2013 Dec;29(12):810-5. References