Sarcouncil Journal of Medicine and Surgery

Abstract: Background: Both the small-incision lenticule extraction (SMILE) and the femtosecond laser-assisted in situ keratomileusis (FS-LASIK) are increasingly used to correct myopia. Both are found to show a high efficacy. Materials and Methods: We performed a thorough systematic review for 10 articles with meta-analysis in PubMed, Embase, and Cochrane databases. Doing this, randomized controlled trials (RCTs), prospective/retrospective comparative cohorts, and network meta-analyses comparing the two procedures in adult patients with stable myopia were included. Primary endpoints consisted of the incidence/severity of DED, corneal sensitivity, and flap complications. Secondary outcomes included uncorrected/corrected distance visual acuity (UDVA/CDVA), predictability of the MRSE, higher order aberrations (HOAs), and long-term refractive stability. The Cochrane RoB 2 and ROBINS-I tools were used to assess the risk of bias. Random-effects models were used to calculate pooled effect estimates. Results: All references involving multiple comparative cohorts or meta-analyses were included in the results. The effectiveness and safety of both procedures was equivalent for meeting the final UDVA/CDVA and the MRSE targets. SMILE always showed a better topographic profile of the eye surface, a lower number of DED symptoms, preserved corneal sensitivity, longer TBUT, and fewer of the postoperative problems with glare symptoms. With the use of corneal topography-guided ablation profiles, early visual recovery and predictability (MRSE) were faster for those receiving FS-LASIK. FS-LASIK was the only procedure associated with flap-related complications, and SMILE preserved corneal biomechanical properties and minimised the induction of spherical aberration, especially in high myopia. Summary: Knowledge of these differences in complication profile and recovery experience should inform the choice of SMILE or FS-LASIK for correcting myopia.