Results of thin-cap small-incision lenticule extraction

J Cataract Refract Surg. 2021 Apr 1;47(4):439-444. doi: 10.1097/j.jcrs.0000000000000470.


Purpose: To evaluate the influence of a thin cap in small-incision lenticule extraction (SMILE) for the correction of myopia or myopic astigmatism.

Setting: Tertiary care private practice.

Methods: A chart review of 102 eyes of 51 patients was performed. The effect of 120 µm vs 100 μm cap thickness on postoperative spherical equivalent refraction (SEQ), cylinder, corrected and uncorrected visual acuities, and ease of lenticule separation was assessed in a contralateral manner, whereas all other parameters were identical between eyes (including optical zone, minimum lenticule thickness, incision size, and energy and spot settings) using paired t test.

Results: At 3 months postoperatively, SMILE with 120 μm cap thickness was undercorrected in SEQ relative to SMILE with 100 μm cap thickness in a cohort of 102 eyes of 51 consecutive patients. The difference of 0.06 ± 0.39 diopter (or 0.7% ± 5.7%) did not reach statistical significance. Postoperative cylinder was not statistically different in both groups. Visual acuity was similar in both groups. Ease of lenticule separation was identical in both groups. Suction time was shorter with a 100 μm cap (P < .005). Postoperative central residual stromal thickness was 20 ± 15 μm thicker with a 100 μm cap (P < .0001). Adverse events were comparable.

Conclusions: Postoperative refraction, visual acuity, ease of lenticule separation, and incidence of adverse events were not significantly affected by cap thickness. Surgeons might safely use 100 μm instead of 120 μm caps without nomogram adjustment. Alternatively, after suction loss during the lenticule cut, a second docking with a programmed cap thickness of 100 μm (and a larger optical zone) might be a rescue technique enabling surgeons to still perform the intended SMILE procedure.

MeSH terms

  • Astigmatism* / surgery
  • Corneal Stroma / surgery
  • Corneal Surgery, Laser*
  • Humans
  • Lasers, Excimer / therapeutic use
  • Myopia* / surgery
  • Refraction, Ocular
  • Visual Acuity