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“Small Incision Lenticule

Extraction (SMILE)”

By:
Arum Sekar Latih (1102012029)
Chairunnisa Rifka Windiputri(1102012044)
Ibramu Al Furqan (1102012115)
Relanfa Farando (1102012234)

OPTHALMOLOGY DEPARTEMENT
BHAYANGKARA TK.1 R.S. SUKANTO HOSPITAL
16 OCTOBER - 17 NOVEMBER 2017
YARSI UNIVERSITY
MEDICAL SCHOOL
Introduction

In the original keratomileusis procedure for myopia, an


approcimately 300 mm thick disc was dissecred from the
anterior cornea in a freehand fashion and reshaped using
a cryolathe

1980’s: Ruiz developed an automated microkeratome


that controlled speed as it passed across the cornea, this
procedure has become known as automated lamellar
keratoplasty (ALK).
1990’s: Developed combination of a icrokeratome and an
excimer laser (for the refractive cut) was this procedure
known as laser assisted in situ keratomileusis (LASIK).

Femtosecond lasers have become available for the cutting


of the intrastromal lenticule and subsequent lenticuler
extraction. The intrastromal lenticule is removed using flap-
like access. In small incision lenticule extraction (SMILE), the
incision is minimized and the procedure does not use a flap.
SMILE provides good outcomes in terms of refraction as
well as additional benefits, such as a reduction in
scatter that leads to better vision quality

SMILE does not involve any flap creation, which


potentially reduces risk of side effects such as dry eyes
and other flap related complications. Unlike LASIK which
uses an excimer laser to ablate corneal tissue, SMILE cuts
and removes a piece of corneal lenticule, which may be
stored and replaced into the cornea later on.
The corneal anatomy
The cornea is the transparent front part of
the eye that covers the iris, pupil and anterior
chamber.

The cornea, with the anterior chamber and lens,


refracts light, with the cornea accounting for
approximately two-thirds of the eye's total optical
power
Structure
• The cornea has unmyelinated nerve endings sensitive to
touch, temperature and chemicals
• The cornea does not have blood vessels.
• Nutrients are transported via diffusion from the tear
fluid through the outside surface and the aqueous
humour through the inside surface, and also
from neurothropins supplied by nerve fibres
• The most abundant soluble protein in mammalian
cornea is albumin
The tissues of the cornea (anterior to posterior)
PHISIOLOGY
Preoperative examination
Inclusion criteria
Preoperative preparation
SMILE PROCEDURE
CONTRAINDICATIONS
COMPLICATIONS
Discussions
• SMILE is a fairly new procedure of corneal refractive
surgery. this femtosecond laser flap-free refractive
procedure demonstrates predictability, safety, and
efficacy similar to that of femtosecond laser–assisted
LASIK.
• SMILE provides good outcomes in terms of refraction
as well as additional benefits.
• SMILE procedures eliminates flap displacement, and
there is no risk of the flap dislocating with trauma to
the eye at a later point.