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Review
. 2021 Apr 24;11(2):113-121.
doi: 10.4103/tjo.tjo_12_21. eCollection 2021 Apr-Jun.

Advances in refractive corneal lenticule extraction

Matthias Fuest  1 , Jodhbir S Mehta  2   3   4   5
Affiliations
Review

Advances in refractive corneal lenticule extraction

Matthias Fuest et al. Taiwan J Ophthalmol. .

Abstract

Refractive errors are the leading cause of reversible visual impairment worldwide. In addition to the desired spectacle independence, refractive procedures can improve quality of life, working ability, and daily working performance. Refractive corneal lenticule extraction (RCLE) is a relatively new technique, dependent only on a femtosecond laser (FS). This leads to potential benefits over laser-assisted in situ keratomileusis (LASIK) including a quicker recovery of dry eye disease, a larger functional optical zone, and no flap-related complications. SMILE, available with the VisuMax FS (Carl Zeiss Meditec AG, Jena, Germany), is the most established RCLE application, offering visual and refractive outcomes comparable to LASIK. SmartSight (SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) and CLEAR (Ziemer Ophthalmic Systems AG, Port, Switzerland) are two new RCLE applications that received Conformité Européenne (CE) approval in 2020. In this article, we review refractive and visual outcomes, advantages, and disadvantages of RCLE and also report on the latest advances in RCLE systems.

Keywords: Cornea corneal surgery; laser refraction; ocular refractive surgical procedures.

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Conflict of interest statement

The authors declare that there are no conflicts of interests in this paper.

Figures

Figure 1
Figure 1
Three femtosecond laser (FS) platforms currently allow refractive corneal lenticule extraction (RCLE). The SCHWIND ATOS FS (a; SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany) received CE approval for its SmartSight application in July 2020 and the FEMTO LDV Z8 FS (c; Ziemer Ophthalmic Systems AG, Port, Switzerland) for its CLEAR program in April 2020. SMILE, available with the VisuMax FS (b; Carl Zeiss Meditec, Jena, Germany), is the only current RCLE application with CE and FDA approval. The images were provided by the manufacturers.[252627]
Figure 2
Figure 2
Guiding incisions (green) and tunnels (red) used in modern refractive corneal lenticule extraction (RCLE). In this case one incision guides the surgeon to the posterior and one to the anterior surfaces of the lenticule to be delineated directly and independently. This option is available with the CLEAR program on the FEMTO LDV Z8 platform (Ziemer Ophthalmic Systems AG, Port, Switzerland) and helps to prevent lenticule mis-dissection, one of the most common intraoperative complications in RCLE[27]
Figure 3
Figure 3
Intraoperative optical coherence tomography (iOCT) can be used in CLEAR on the FEMTO LDV Z8 platform (Ziemer Ophthalmic Systems AG, Port, Switzerland)[27]
See this image and copyright information in PMC

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