What are the ReLEx SMILE risks?

Dr. Christoph Kranemann discusses the risks associated with ReLEx SMILE laser eye surgery.

Christoph Kranemann: The risks with SMILE are, overall, the same risk of any laser vision correction.

There is some transient dryness, although, there is a significantly shorter period of dryness than we see with other laser vision correction procedures. There is still a small risk of overall under correction. From our experience, the need for touch-ups with SMILE patients is much less than for other laser vision correction patients. It certainly has proven itself to be a very accurate and precise treatment.

Again, with any treatment, the mere fact that we’re touching something, there may be a small risk of infection. There is a low risk that we can make some unrecognisable, structural weakness a bit worse, and for that, we have to do a strengthening treatment afterwards. That risk appears to be significantly less than with something like LASIK because we’re preserving the structural integrity of the tough layer upfront, which we’re not doing with LASIK.

There is that small chance that there may be some change over time. Again, the European data suggest there’s less chance of that drift because we’re leaving that tough layer intact upfront. Whereas with the other treatments, we’re fundamentally weakening the tough layer. It would be only logical, and that seems to bear out on reality, that the results will be more stable, and sturdy, over time.

With any procedure that has an interface, or a space between two layers, there’s a small possibility that the surface tissue that replenishes itself, called the epithelium, develops in between. With LASIK, we call that in-growth, and it has to be removed by the surgeon. This process can be quite bothersome at times.

With SMILE, few of the epithelial cells may get dislodged into the layer in between, and because it multiplies, it tends to grow. Now, the nature of the laser makes the two sides of the interface quite sticky and so It won’t go very far because it sticks down. However, sometimes there is the need to remove this collection of epithelial cells that we once referred to as a little plug. At some point in the first months or so after the procedure, it tends not to recur.

With LASIK and the flap, however, it can be a more recurrent and bothersome issue. This is because there’s a more natural way for this to occur and because you have to lift the whole flap up to remove it. Whereas in SMILE, you do not have to lift and open up the entire interface.