the relex smile technique in refractive surgery · relex smile: flapless & minimally invasive...
TRANSCRIPT
The ReLEx SMILE Technique
in refractive surgery
Moschou Konstantinos M.D.
Diathlasis Day Care Unit
2016 TVRS Open Day
Electra palace
Thessaloniki Mediterretina School
I HAVE NO FINANCIAL INTEREST
Diathlasis Day Care Unit, Thessaloniki, Greece
VisuMax – the only femtosecond laser made for ReLEx SMILE
Diathlasis Day Care Unit, Thessaloniki, Greece
Spherical patient interface and unique corneal
suction for minimum eye irritation
Less tissue compression
Automated vacuum system
Shortest suction time
Minimal IOP increase
No vision loss during suction
Lowest IOP increase during treatment for all
fs-systems on the market
VisuMax – the only femtosecond laser made for ReLEx SMILE
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx The next generation method for laser vision correction
PR
K
LASEK
Epi-LASIK
LA
SIK
Standard LASIK
Femto-LASIK
R
eL
Ex
Flex Femtosecond Lenticule Extraction
Smile Small Incision Lenticule Extraction
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx SMILE The 3rd generation Laser Vision Correction
“SMILE is LASIK without a flap and PRK without pain.”
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx
ReLEx®
ReLEx® SMILE
ReLEx® FLEX
Femtosecond Lenticule Extraction Small Incision Lenticule Extraction
Advancement
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx flex
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx Released treatment range for myopic indication
ReLEx option for VisuMax provides the following indication range:
Myopic sphere range: -0.50 … -10.00 D
Cylinder range: 0 … 5.00 D
Spherical equivalent range: -0.75 … -10.00 D
The ReLEx myopic treatment range covers almost 85% of the common
patients population
ReLEx shows excellent outcomes for higher corrections > -7 D opening a
new target segment
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx smile Flapless. All-femto. Single step.
Step 1
In a single step, the VisuMax
Femtosecond laser creates a
refractive lenticule and a small
incision of less than 4mm in the
otherwise intact cornea – more or
less regardless of the ambient
conditions or individual corneal
stucture.
Diathlasis Day Care Unit, Thessaloniki, Greece
Step 2
The lenticule is then manually
removed through a very small
incision in the cornea. This
means there is no need for a flap
cut, and the disruption to the
biomechanics of the cornea is
minimal in comparison to other
methods.
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx smile Flapless. All-femto. Single step.
Step 3
The removal of the
refractive lenticule changes
the shape of the cornea,
permanently correcting the
refractive error.
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx smile Flapless. All-femto. Single step.
ReLEx SMILE: flapless & minimally invasive Small incision - big advantage
Minimally invasive surgery: 80% less
side cut (compared to LASIK) 30% less
cap cut
Greater integrity of upper corneal layers
Indicates preservation of corneal
biomechanical stability
SMILE combines the advantages of PRK and LASIK.
Diathlasis Day Care Unit, Thessaloniki, Greece
Less nerves severed
Indicates less varying severity of dry eye syndrome
No flap ⇾ minimizes the risk for flap complications such as
epithelium ingrowing, flap dislocation, infections
Faster healing of epithelium
ReLEx SMILE: flapless & minimally invasive Small incision - big advantage
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx All-Femto: precise and robust Lenticule extraction advantages over cornea ablation
No laser calibration or fluency test with impact on treatment
result required
No controlled airflow and plume removal necessary
Refractive correction by femtosecond lenticule cut is not affected
by ambient room conditions
Fully corrected optical zone from center to periphery
Corneal topography maps post-op confirm prolate shape of optical
zone
ReLEx SMILE user reports showed lower induction of wavefront
errors than LASIK, in particular for spherical aberration
Diathlasis Day Care Unit, Thessaloniki, Greece
Single step: fast & efficient A new principle for a better workflow
ReLEx
Flap cut
Patient transfer
Tissue ablation
LASIK
Flap opening
Lenticule cut
Lenticule extraction
12 min*
20 min*
Femto laser
Manual
surgery
Excimer laser
Diathlasis Day Care Unit, Thessaloniki, Greece
Diathlasis Day Care Unit, Thessaloniki, Greece
Diathlasis Day Care Unit, Thessaloniki, Greece
Diathlasis Day Care Unit, Thessaloniki, Greece
Diathlasis Day Care Unit, Thessaloniki, Greece
Diathlasis Day Care Unit, Thessaloniki, Greece
Diathlasis Day Care Unit, Thessaloniki, Greece
ReLEx SMILE The new surgical procedure
Diathlasis Day Care Unit, Thessaloniki, Greece
Statistical analysis of ReLEx SMILE, based on a sample of Diathlasis Day Care Unit.
Gender distribution
Prefecture distribution
Age distribution
Distribution of pre-operative & post-operative SE refraction
Predictability
Stability (post-operative SE 1w, 1m, 3m, 6m & 12m)
Seasonality (preferred season undergoing SMILE procedure)
Diathlasis Day Care Unit, Thessaloniki, Greece
Gender Distribution
27%
73%
Diathlasis Day Care Unit, Thessaloniki, Greece
Prefecture Distribution
Diathlasis Day Care Unit, Thessaloniki, Greece
Age Distribution
Diathlasis Day Care Unit, Thessaloniki, Greece
Statistical analysis of patients, undergone ReLEx SMILE
Age = (28.400 ± 5.935) years 21 years < Range of Age < 48 years SE refraction = (-6.911 ± 1.791) D -2.500D < SE refraction range < -12.000D SE correction = (-0.143 ± 0.435)D 0.625D < SE correction range < -2.250D
Mean Standard
Deviation Mode Range
Age (n=150 eyes) 28.400 5.935 23 21 48
Pre-operative SE
(n=146 eyes) -6.911 1.791 -5.5 -2.500 -12.000
Post-operative SE
(n=146 eyes) -0.143 0.435 0.00 0.625 -2.250
Diathlasis Day Care Unit, Thessaloniki, Greece
Distribution of pre-operative SE refraction
Pre-operative SE (D) Eyes (n=146) Eyes (%)
> 10.50 3 2%
-8.01 to -10.50 37 25%
-6.01 to -8.00 55 38%
-3.01 to -6.00 50 34%
-3.00 < 1 1%
total eyes (n) 146 100%
Diathlasis Day Care Unit, Thessaloniki, Greece
0
20
40
60
80
100
120
> -2.25 -1.01 TO -2.25 -0.51 TO -1.0 -0.01 TO -0.50 0.00 +0.01 TO +0.65
0 7 11 12
103
13 0,0% 4,8% 7,5% 8,2%
70,5%
8,9%
Eyes
(n)
1 month post operative SE (D)
Post-operative SE for patients undergone SMILE procedure
Eyes (n=146) Eyes (%)
Post-operative SE (D) Eyes (n=146) Eyes (%)
> -2.25 0 0.0%
-1.01 to -2.25 7 4.8%
-0.51 to -1.0 11 7.5%
-0.01 to -0.50 12 8.2%
0.00 103 70.5%
+0.01 to +0.65 13 8.9%
Distribution of post-operative SE refraction
Diathlasis Day Care Unit, Thessaloniki, Greece
Predictability of ReLEx smile 1 month post-operative correction
Diathlasis Day Care Unit, Thessaloniki, Greece
Stability of SE Refraction for 1 month, 3 months, 6months & 12 months post-operative outcome
Diathlasis Day Care Unit, Thessaloniki, Greece
Preferred season
SMILE
Season Eyes (n=150) %
Spring 40 27%
Summer 36 24%
Autumn 32 21%
Winter 42 28%
Diathlasis Day Care Unit, Thessaloniki, Greece
CONCLUSION
ReLEx smile is an exciting new treatment in refractive surgery
Better biomechanical stability
Patients in the ReLEx SMILE group had fewer higher-order
aberrations after surgery compared with femtosecond LASIK
patients
Significantly reduce risk of developing dry eyes
Indicated for athletes and for people involved in sports
Diathlasis Day Care Unit, Thessaloniki, Greece
Thank you and don’t forget to smile!
The moment flapless surgery becomes clearly visible: in a smile.
Diathlasis Day Care Unit, Thessaloniki, Greece