Name

CIRCLE apres Relex SMILE

The paper presents a clinical case of  residual astigmatism correction after ReLex SMILE surgery, using the CIRCLE technique.

A regular case of myopic astigmatism that presents for refractive correction, even if after cycloplegic refraction a +0.50 spherical diopter appeared in one eye, I decided to perfome ReLex SMILE for both eyes. Cyclotorsion was taken into consideration, before dockig procedure, no complications were noticed during the surgery, but an important residual astigmatism remain and bothered the patient very much. After one year of regular checks, and tests, as nothing happend I decided to proceed for an enhancement.

Before Relex SMILE procedure, the dominant's eye, right eye cycloplegic refraction was +0,50 Dsph/ -3 Dcyl and left eye was slightly ambliopic with myopic astigmatism; the residual diopter was +0,50 Dsph/-2 Dcyl, for left eye almost plano refraction was obtained. As eye dominance changed, the patient was really disturb binoculary. After Circle +0,25 Dsph/ +0,50 Dcyl; uncorrected visual acuity 0,9 for this eye.

Circle technique is a flap creation, with subsequent excimer laser ablation, Smile cap is converted into a flap and the hinge is moved from it’s regular position, in order not to superimpose with SMILE incision. In the case presented above the results were spectacular, even the next day after the enhancement, as eye dominance was reestablish and patient was extremly happy with the results.

Enhancements after SMILE are very rarely needed and Circle is considered to be the one of the best choices. In this case, +0.50 Dsph that appeared in the cycloplegic refraction, was probably the trigger for under correction.