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J Cataract Refract Surg. 2019 Apr;45(4):515-518. doi: 10.1016/j.jcrs.2018.11.030. Epub 2019 Jan 25.

Small-incision lenticule extraction in a patient with high astigmatism and nystagmus.

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London Vision Clinic, London, United Kingdom; Biomedical Science Research Institute, Ulster Univesity, Coleraine, United Kingdom; Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA; Faculty of Medicine, Sorbonne University, Paris, France. Electronic address:
London Vision Clinic, London, United Kingdom.


Small-incision lenticule extraction (SMILE) was performed in a patient with high astigmatism and nystagmus. The patient presented for a refractive surgery evaluation with a manifest refraction of -0.50 -6.00 × 137 (20/40-1) in the right eye and -2.25 -2.25 × 30 (20/40-1) in the left eye. The patient was deemed suitable for corneal laser refractive surgery. Consideration was given to SMILE, laser in situ keratomileusis, and photorefractive keratectomy. It was decided SMILE was the best option given that the refractive portion of the procedure is performed while the cornea is immobilized by suction. The treatment was uneventful, and the final manifest refraction was +0.25 -0.25 × 130 (20/40) in the right eye and +0.25 diopter sphere (20/40) in the left eye. Topography was normal, showing a well-centered treatment zone. This case highlights an additional use for SMILE, given its ability to immobilize the cornea during treatment.


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