CIRCLE Enhancement After Myopic SMILE.

PURPOSE: To report the outcomes of enhancement after small incision lenticule extraction (SMILE) using the VisuMax CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), which converts the SMILE cap into a femtosecond LASIK flap for secondary excimer laser application. METHODS: Of 2.065 SMILE procedures, 22 eyes (1.1%) re-treated with CIRCLE with a follow-up of 3 months were included in the analysis. SMILE was performed in the usual manner. For re-treatment, the CIRCLE procedure was performed with pattern D flap creation on the VisuMax system and subsequent excimer laser ablation with a Zeiss MEL 90 laser (Carl Zeiss Meditec) with piano target in all cases. RESULTS: Spherical equivalent was -5.56 +/- 2.22 diopters (D) before SMILE and -0.51 +/- 1.08 D before CIRCLE, CIRCLE enhancement was performed after a mean of 10.0 +/- 7.9 months, allowed for safe flap lifting in all eyes, and resulted in a final manifest refraction spherical equivalent of 0.18 +/- 0.31 D at 3 months (P < .008), The number of eyes within 0.50 and 1.00 D from target refraction increased from 31.8% to 90.9% and from 77.3% to 100%, respectively. Mean uncorrected distance visual acuity (UDVA) had already improved from 0.37 <= 0.16 to 0.08 <= 0.18 logMAR at 1 week (P < .0001), resulting in 0.03 <= 0.07 logMAR at 3 months (P < .0001), All eyes gained at least one line of UDVA. Corrected distance visual acuity (CDVA) remained unchanged at all time points (before vs after CIRCLE, P = .40), Two eyes (9.1 %) lost one line of CDVA; no eye lost two or more lines. The safety and efficacy indices were 1.03 and 0.97 at 3 months, CONCLUSIONS: The CIRCLE procedure represents an effective re-treatment option after SMILE, Compared to surface ablation re-treatment after SMILE, CIRCLE seems to offer advantages in respect to speed of visual recovery, safety, and predictability, but at the price of flap creation.