Lower Femtosecond Laser Energy Levels Lead to Better Visual Recovery After Small-incision Lenticule Extraction for Myopia

Small-incision lenticule extraction (SMILE), the most recently developed refractive surgical technique, is being performed in a growing number of cases. This intrastromal keratomileusis using only a femtosecond laser is a new procedure that extracts the refractive lenticule through a small corneal incision ranging from 2 to 5 mm, with the absence of a flap and the preservation of the anterior-most stromal lamellae and Bowman's layer (except for the region of the small incision). Many studies have demonstrated that SMILE achieved comparable or superior efficacy, safety, and predictability to femtosecond laser -assisted in situ keratomileusis (FS-LASIK) and femtosecond lenticule extraction (FLEx). However, the recovery of visual acuity in the early postoperative period after SMILE is slower, compared to other refractive surgery techniques. Therefore, adjusting energy might improve postoperative visual acuity and recovery time after SMILE. Nevertheless, the optimal parameters drawn from a well-organized randomized study have yet to be elucidated. The purpose of this study was to investigate the optimal femtosecond laser energy, with the aim of improving clinical outcomes during the early postoperative period after SMILE for the correction of myopia. To this end, we used a 500 kHz VisuMax with spot-spacing control at energy levels lower than 115 nJ, based on the previous studies. Therefore, we prospectively compared visual outcomes of two groups randomly divided by different laser energies: one underwent SMILE using lower energy levels of 100, 105, and 110 nJ (L-SMILE), while the other group underwent SMILE at energy levels conventionally used of 115 to 150 nJ (C-SMILE).