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SMILE Refractive Surgery

Small Incision Lenticule Extraction: flapless femtosecond laser refractive procedure that creates and removes an intrastromal corneal lenticule through a small incision to correct myopia and astigmatism.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is SMILE Refractive Surgery?

SMILE (Small Incision Lenticule Extraction) is a third-generation refractive surgery using only a femtosecond laser (no excimer laser, no flap) to create a precise intrastromal lenticule that is manually extracted through a small peripheral incision (2-4 mm).

By avoiding the corneal flap of LASIK, SMILE preserves more anterior corneal nerves and biomechanical integrity, theoretically reducing risk of post-surgical dry eye, ectasia, and flap-related complications. Treatment takes about 25-30 seconds per eye.

SMILE corrects myopia (-1 to -10 D) and myopic astigmatism (up to -3 D) but currently has limited approval for hyperopia. Modern platforms (VisuMax 800) allow faster treatment, real-time imaging, and improved centration.

Symptoms

Myopia (nearsightedness) -1 to -10 diopters
Myopic astigmatism up to -3 diopters
Active lifestyle (sports, military) where flap displacement is concern
History of dry eye where LASIK is relatively contraindicated
Desire for minimally invasive flapless procedure
Stable refraction for at least 1 year
Age 22 years or older (younger ages require careful evaluation)

Risk Factors

Hyperopia (limited SMILE platform availability)
Severe astigmatism (>-3 D) requires alternative procedure
Keratoconus or corneal ectasia (contraindication)
Inadequate corneal thickness (<500 μm)
Severe dry eye disease or autoimmune conditions
Pregnancy or breastfeeding
Inability to fixate or cooperate during 25-30 second laser application

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe eye pain, redness, or vision loss after SMILE
  • Persistent halos, glare, or night vision difficulties beyond 3 months
  • Suction loss or interrupted treatment requiring conversion
  • Suspected lenticule remnant or interface debris
  • Regression of refractive error or undercorrection
  • Suspected post-SMILE ectasia (rare)
  • Worsening dry eye despite lubricants (less common than LASIK)

Treatment Methods

01
Comprehensive preoperative evaluation (topography, pachymetry, biometry)
02
Femtosecond laser lenticule creation in single docking session
03
Manual lenticule extraction through small peripheral incision
04
Topical anesthesia, no flap creation, no excimer ablation
05
Postoperative antibiotic and corticosteroid drops for 1 week
06
Lubricant drops for 1-3 months (typically less than LASIK)
07
Enhancement options: PRK, surface ablation, or thin-flap LASIK if undercorrected

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Göz Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.