Tissue Addition, Pocket Crosslinking Help Manage SMILE-Related Ectasia

New Vision clinic, main center for refractive surgery in France, with cutting-edge technology for all eye laser operations. Eye operation using the SMILE, Small Incision Lenticule Extraction, laser technique. It is a new generation of treatment which enables short-sightedness to be corrected without removing the superficial layer of the cornea, nor opening it. The SMILE technique involves producing with the Femtosecond laser, a lenticule, thin slice, in 3D in the thickness of the cornea, and removing it with a micro incision in the shape of a smile. The worse the short-sightedness, the thicker the lenticule. (Photo by: BSIP/Universal Images Group via Getty Images)
A report reviews the feasibility of managing ectasia that develops after a refractive procedure using a combination of 2 techniques.

Tissue addition, combined with accelerated crosslinking using small incision lenticule extraction (SMILE)-derived donor lenticule, may be an option for managing patients who developed ectasia after the procedure, according to findings published in the Journal of Cataract & Refractive Surgery. The technique may reduce keratometry and higher-order aberrations.

Keratectasia can occur following to SMILEprocedure, according to investigators. Prior research shows that conventional epithelium-off crosslinking alone, or combined with phototherapeutic keratectomy, are safe and effective methods for stabilizing this ectasia.

In this study, researchers examine the feasibility of managing ectasia after SMILE using tissue addition and pocket corneal crosslinking (CXL). The 4 eyes of 3 patients (mean age 25.7 years) developed keratectasia features at a mean period of 3 years after undergoing SMILE for myopia. All cases were managed by inserting heterologous SMILE lenticules in the previously created pocket, followed by simultaneous accelerated CXL. 

At a mean follow-up of 7.67 months, researchers noted improvements in corrected distance visual acuity and reductions in keratometry and higher-order aberrations in all eyes that were managed with this technique. Visual, refractive, and topographic parameters remained stable at the last visit compared with the 2-week follow-up visit. No eye developed haze, infection, or rejection requiring tissue removal, according to the findings.

Disclosure: Several study authors declared affiliations with the biotech of pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.


Ganesh S, Brar S, Bowry R. Management of small-incision lenticule extraction ectasia using tissue addition and pocket crosslinking. J Cataract Refract Surg. 2021;47(3):407-412. doi:10.1097/j.jcrs.0000000000000335.