Clinical Outcomes of Small Incision Lenticule Extraction with Accelerated Cross-Linking (ReLEx SMILE Xtra) in Patients with thin cornea: six months follow-up

Purpose: To study the safety and clinical outcomes of ReLEx SMILE with accelerated cross-linking in eyes with thin cornea. Methods: six eyes with thin cornea, corrected distance visual acuity 20/40 or better, stable refraction of at least 1 year, age 18 years or older, and residual corneal thickness of greater than 400 mm before performing collagen crosslinking were studied.Following the removal of lenticule, 0.25% riboflavin in saline was injected into the interface and allowed to diffuse for 60 seconds. Finally, eye was exposed to UV-A radiation of 45mW/cm2 for 75 seconds through the cap. Total energy delivered was 3.4 J/cm2. Results: 3 patients with mean age of 26.75 ± 5.99 years were treated. Mean follow-up was 6 months ± 28.12 days. Mean spherical equivalent (SE) was 5.02 ± 2.06D preoperatively and 0.24 ± 0.18D postoperatively. The mean central corneal thickness (CCT) and keratometry changed from 501 ± 25.90 m to 415 ± 42.26 m and 45.40 ± 1.40D to 41.2 ± 2.75D, respectively. Mean uncorrected visual acuity (UCVA) was 20/25 or better in all eyes. No eyes lost lines of corrected distant visual acuity (CDVA). There were no complications like haze, keratitis, ectasia, or regression.Conclusion: Based on the initial clinical outcome it appears that SMILE Xtra may be a safe. although further follow-up and larger samples are needed to fully confirm these findings, the results suggest that combined smallincision lenticule extraction and intrastromal corneal collagen crosslinking are a promising treatment option for patients for whom conventional laser refractive surgery is contraindicated