SMILE Lenticule Implantation

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Article initiated by:
Andrew Yazji, M.D., Isabella Yazji, B.A., Martin Mayers, William F. Wiley, MD
All contributors:
Eric Weinlander, MD, Colleen Halfpenny, M.D., Andrew Yazji, M.D., Jeremy N. Shapiro
Assigned editor:
Eric Weinlander, MD, Isa S. K. Mohammed, MD
Review:
Assigned status Update Pending
 by Eric Weinlander, MD on July 30, 2025.


SMILE Background

Small incision lenticule extraction (SMILE) uses a femtosecond laser to create a lenticule within the stroma of the cornea, which is then manually removed through a small peripheral incision to correct myopia and myopic astigmatism.[1] The procedure is now more broadly categorized under the umbrella term keratorefractive lenticule extraction (KLEx), which encompasses multiple platforms including SMILE (VisuMax 500), SMILE Pro (VisuMax 800), SmartSight (SCHWIND), CLEAR (Ziemer), and SILK (Johnson & Johnson Vision).[2]

With national and international corneal donor shortages continuing to pose a significant hurdle for patients, SMILE lenticules have been proposed and trialed as allogenic, transplantable tissues for both refractive and non-refractive indications.[3] With SMILE increasing in popularity and with a growing biorepository of these lenticules, the traditionally discarded extracted SMILE lenticule may represent a clinically useful biomaterial for numerous corneal indications.[4] Experimental use of the extracted lenticule has been described as an allogenic corneal inlay. This article discusses potential uses of SMILE lenticule implantation as an allogenic corneal inlay on onlay.

SMILE Procedure Steps

The sequence of images above show the extraction of the SMILE lenticule. Image “A” faintly shows an inner and outer ring of tissue; the SMILE lenticule is the inner ring[5].

A brief overview of the SMILE procedure steps are included. The surgery is performed with the patient under topical anesthesia. The use of a femtosecond laser forms an intrastromal lenticule with a small incision. The lower interface is first formed, and then the upper interface, which is known as the cap. A tunnel incision of 2-3 mm is created which connects this cap interface with the corneal surface.[6] The excision of the lenticule is then performed through blunt separation of the anterior and posterior surfaces, followed by removal with retinal micro-forceps or a lenticule stripper instrument.[5][7]  Prior to starting the procedure, the surgeon selects for certain factors, including refractive correction and the diameter and minimum thickness of the lenticule. This ensures the lower and upper interfaces can more easily be separated, leading to higher probability of successful lenticule extraction.[6]

Current KLEx Platforms

The various KLEx procedures currently on the market differ significantly in their laser platforms, technical parameters, and clinical nuances. Their unique features are discussed below, and more information on each platform can be found here: Keratorefractive Lenticule Extraction (KLEx) Surgeries.

SMILE (Carl Zeiss Meditec — VisuMax 500)

The VisuMax 500 operates at a repetition rate of 500 kHz with pulse energies typically in the range of 105–165 nJ and with an average lenticule creation time of 27-28 seconds.[8][9] This technique has the largest body of published evidence to support it and is FDA-approved for myopia with or without astigmatism (sphere ranging from -1.00 to -10.00 D and refractive cylinder up to -3.00 D).

SMILE Pro (Carl Zeiss Meditec — VisuMax 800)

The VisuMax 800 platform operates at a repetition rate of 2 MHz. Compared to the VisuMax 500, it has been shown to offer dramatically shorter lenticule creation time (~10 seconds versus ~28 seconds), improved centration accuracy, lower vertical coma induction, better lenticular surface regularity, and reduced opaque bubble layer.[10][11][12][13] This technique is FDA-approved for correction of myopia and myopic astigmatism with literature describing its successful use for myopia up to -10.00 D and astigmatism up to 5.00 D.

SmartSight (SCHWIND eye-tech-solutions — ATOS)

The SCHWIND ATOS platform uses a high-repetition-rate femtosecond laser with notably low pulse energy (as low as 75–90 nJ at conventional settings) and adjustable spot/track spacing. The low pulse energy and high repetition rate may contribute to smoother lenticule surfaces and reduced opaque bubble layer, contributing to more rapid patient recovery.[14][15][16][17] Notably, centration and cyclotorsion compensation are integrated into the platform, distinguishing it from the VisuMax 500 and 800. This platform is being deployed in the European Union (EU) but has not yet received FDA approval.

CLEAR (Ziemer Ophthalmic Systems — FEMTO LDV Z8)

The Ziemer FEMTO LDV Z8 uses a very high repetition rate (>5 MHz) with very low pulse energy (<50 nJ) and a liquid optics interface (rather than a curved contact glass), which is unique among KLEx platforms.[16][17]The platform offers a flat applanation surface with liquid interface, providing suction control and computerized regulation of centration and alignment. It also offers Q-value individualized aspheric lenticule profiles, which preserve corneal asphericity and minimize spherical aberration induction — a distinctive advantage from other techniques.[17][18] It has been deployed in the EU, but has also not yet been FDA-approved.

SILK (Johnson & Johnson Vision — ELITA Femtosecond Laser)

The ELITA platform performs Smooth Incision Lenticular Keratomileusis (SILK), using a high-repetition-rate (10 MHz) femtosecond laser with a proprietary lenticule cut pattern.[19][20] FDA approval is pending.

SMILE Complications

Complications of SMILE include corneal epithelial defects, tearing or perforation of the incision, loss of suction with the laser, creation of a bubble layer or black spots, and lenticule remnants within the corneal stroma. After the procedure, corneal haze, ocular inflammation, and delayed recovery of the patient’s vision can occur.[21] Since the lack of flap creation and further ablation by the excimer laser does not disturb the epithelium, Bowman’s layer, or anterior stroma, post-SMILE ectasia is rare but reported. It may be well-managed with corneal collagen crosslinking (CXL) with or without stromal lenticule addition keratoplasty.[22][23][24] Efforts to better risk-stratify patients for SMILE complications have been attempted with one study showing strong performance of a risk-prediction model for patient suitability.[25]

The SMILE Lenticule

Composition and Immunogenicity

The SMILE lenticule consists of corneal stroma. Within the stroma exists type I collagen, packed into closely arranged fibrils, which then form a greater lamellae unit. Some authors posit that the lack of epithelium and endothelium in the SMILE lenticule reduces the risk of a significant host immune response following implantation of the lenticule.[26] Risk evaluation studies have confirmed that fresh lenticules are negative for HSV-1, HSV-2, bacteria, fungi, and Acanthamoeba, though HLA-I and HLA-II antigens are expressed in fresh tissue. These antigens are significantly reduced after preservation in anhydrous glycerol at -78 °C or after decellularization.[27]

Lenticule Preservation

Lenticule preservation techniques are an active area of study to improve short and long-term lenticular biocompatibility. The various short and long-term preservation techniques under investigation are outlined below.

Short-term (days to one month) storage methods

48 hours has been proposed as the maximum time of short-term storage for lenticule transportation.[28] Dulbecco’s Modified Eagle’s Medium (DMEM) supplemented with 10% fetal bovine serum (FBS) at 4 °C, phosphate-buffered saline (PBS) at 4 °C, Optisol-GS at 4 °C, and pure glycerol at room temperature were each shown by Liu et al to maintain structural integrity, transparency, and low immunogenicity of lenticules at 48 hours and four weeks.[28][29] The greatest maintenance of clarity at four weeks was seen in the lenticules stored initially in DMEM at 4 °C for 48 h and subsequently with cryopreservation in serum-free medium or in glycerol at 4 °C with subsequent storage at room temperature.[28] Corroborating these findings, Han et al found that lenticules preserved using glycerol at room temperature, silicone oil at room temperature, Optisol-GS at 4 °C, and cryopreservation at -80 °C  all showed similar viability at 1 day, 1 week, and 1 month. Another study found that only Optisol-GS can maintain satisfactory lenticule viability at 4 °C.[30] Still, Optisol-GS can induce cytotoxicity, and further studies are warranted. Unfortunately, the clinical application of the cryopreservation method is limited by its high costs and complexity, and further studies should focus on other storage media that facilitate near-room-temperature storage to decrease the cost and logistical burden of tissue handling.[4]

Long-term (one month to years) storage methods

For long-term storage, lenticules stored in anhydrous glycerol with or without silica gel at -80 °C have shown transmittance nearest to that of fresh lenticules when compared to other, warmer preservation temperatures.[31] Another proposed technique is a hydrogel-based nutrient capsule system, showing increased tissue viability, lower apoptotic rates, and better-preserved collagen architecture when compared to glycerol.[32][33] A non-chemical desiccation technique has also been explored, having been shown in some models to achieve effective long-term preservation with natural decellularization. In a rabbit model, human lenticules preserved with desiccation without chemical treatment and implanted as corneal inlays maintained clarity, showed no rejection, no inflammatory infiltration, and stable thickness over 6 months. This approach is particularly promising for creating an off-the-shelf tissue supply.[4][34] A similar, but different, approach to desiccation is the use of lyophilized decellularized storage, which combines chemical decellularization (Triton X-100 and sodium dodecyl sulfate) with freeze-drying and storage at -20 °C. This method has been shown to preserve tissue morphology and biocompatibility, though it requires chemical processing unlike simple desiccation. Unfortunately, though intended for long-term storage, lyophilized decellularized storage has only been studied using a 24-hour storage protocol.[35]

Despite these advances, more research is needed to further establish optimal storage conditions and agents specific to the intended use of the lenticule, as well as a generalized framework under which regulation and oversight could be instituted.[36][37]

Applications of SMILE Lenticule Implantation

This image shows steps to the proposed sLIKE procedure. A stromal pocket is created using the femtosecond laser (A). The pocket is dissected using a spatula (B). The anterior surface of the implant lenticule is marked (C). The implant is soaked in Trypan blue (D). A special forceps implants the lenticule into the stromal pocket (E). The lenticule is manipulated to ensure correct positioning (F).[38]

Different techniques for lenticule implantation have been described, but certain basic principles are shared across techniques. First, a lenticule is extracted from the donor using one of the established techniques. This can be done from either living or deceased donors and either in vivo or ex vivo. Second, the tissue is stored using an established storage medium with or without cryopreservation. Third, for endokeratophakia (lenticular implantation inside recipient cornea), the recipient cornea is prepared via intrastromal pocket or flap creation, typically using a femtosecond laser in a similar fashion to lenticule extraction, but with monolaminar instead of bilaminar dissection, and the implant is inserted into the pocket or inlaid under the flap.

The term most commonly used in the literature for the general technique is Lenticule Intrastromal Keratoplasty (LIKE), with the term femtosecond laser-assisted LIKE (FS-LIKE) describing the technique utilizing a corneal flap and femtosecond laser small incision LIKE (SMI-LIKE or sLIKE) describing the technique using a smaller keyhole incision for implantation.[39] The term Stromal Lenticule Addition Keratoplasty (SLAK) is also used for these procedures in the literature. Standardization of nomenclature is pending. For epikeratophakia (transplantation by resting or embedding the donor tissue on or into the corneal surface), the recipient cornea can be prepared with transepithelial photorefractive keratectomy (TE-PTK). These transplantations can be done with either autologous or allogenic tissue. Other techniques have been studied for implantation of corneal inlays or onlays with deceased-donor allogenic tissue as well.[40] The indications under investigation for SMILE-derived tissue implantation are discussed below, with a description of the different techniques applicable to each.

Refractive Applications

Hyperopia

Although SMILE itself is not FDA-approved to treat hyperopia, primate studies showed that lenticule implantation can change refractive power to correct hyperopia.[41] A myopic SMILE-derived lenticule, when reimplanted, adds stromal tissue centrally and steepens the cornea. Pradhan et al first reported this method in a human with a satisfactory result in 2013.[42] Sun et al studied five patients in 2015, each with one hyperopic eye and one myopic eye, wherein the myopic eye was treated with SMILE, and the extracted lenticule was then autologously implanted in the hyperopic eye, achieving a mean spherical equivalent (SE) reduction of 5.53 D with stable results at 1 year.[43] A study of 42 eyes with 5-year follow-up demonstrated good safety and efficacy for moderate to high hyperopia (mean SE reduced from +5.50 D to +0.66 D), with 71% of eyes within ±1.00 D.[44] The first case of LIKE for hyperopia in the U.S. was described by Moshirfar in 2020, achieving the intended refractive correction, but with the complications of epithelial ingrowth and flap necrosis.[45] Zhang et al showed in a retrospective study of 24 eyes that astigmatic correction with SMILE followed by allogenic LIKE in the same eye achieved significant improvement in UDVA and SE at 1 year with a good safety profile.[46] Most recently, a 2026 study compared the refractive predictability between a group of 12 eyes that underwent FS-LIKE and a group of 11 eyes that underwent SMI-LIKE for moderate to high hyperopia, finding that FS-LIKE could achieve better refractive predictability than SMI-LIKE, likely explained by differences in corneal remodeling.[47]

A systematic review and meta-analysis by Wang et al. (2023) pooling 10 studies (190 eyes) confirmed that intrastromal lenticule implantation significantly improved UDVA for hyperopia, with 52% of eyes achieving ±0.5 D and 74% achieving ±1.0 D of target SE, and a mean CCT increase of 72.68 μm.[48]

Presbyopia

Correction of presbyopia is one potential use of implantation of the SMILE lenticule. In one study, LASIK was performed in eyes that underwent autologous lenticule implantation after SMILE. Each refractive procedure created a myopic target, with LASIK aiming for 1 D less of myopia, establishing a theoretical monovision between eyes. No difference was seen in corneal tissue response between corneas that had undergone SMILE, lenticule implantation, and then LASIK, versus eyes that only underwent LASIK.[49] By restoring stromal volume and increasing corneal thickness in patients who are status post refractive surgery and have now developed presbyopia, they are afforded the opportunity to undergo a secondary refractive procedure for creation of a presbyopic monovision. Another technique termed the PrEsbyopic Allogenic Refractive Lenticule (PEARL) corneal inlay has been described, in which a SMILE lenticule is trephined at the center to a 1-mm diameter and implanted under a femtosecond laser-created cap in the nondominant eye. Preliminary results in 4 emmetropic presbyopic patients showed improvement in uncorrected near visual acuity from J5-J8 to J2, with maintained 20/20 distance vision with no dysphotopsias reported over 6 months.[50] Another study in 12 presbyopic eyes showed that human cornea tissue derived from deceased donors could be processed to derive excimer laser-shaped lenticules for LIKE, finding that LIKE performed with these tissues enhanced patient visual performance for near vision needs.[51] It is unknown whether the SMILE lenticule yields superior results compared to current corneal inlay therapies offered to patients, although given that the main hurdle for current technologies is appropriate biocompatibility, it presents a promising alternative to biosynthetic approaches.[49][52]

Non-Refractive Applications

Keratoconus

The local corneal thickness of keratoconus becomes thinner, and the anterior surface curvature increases, resulting in highly irregular myopic astigmatism (A). The high myopic astigmatism in patients with keratoconus can be corrected using the concave lenticules removed from hyperopic SMILE surgery (B). This concave lenticules extracted are biocompatible, transparent stromal tissues with a concave geometry, enabling their potential use in correcting refractive errors (C). Method 1 is used to cover the surface of keratoconus where the corneal epithelium has been removed, also known as epikeratophakia (D). Method 2 is when stromal lenticules can be implanted into the corneal stroma using a femtosecond laser to create a pouch, also known as endokeratophakia (E).[4]

Lenticule implantation in eyes with keratoconus has been reported to improve visual acuity and decrease keratometry.[52][53][54][55][56] A 2024 systematic review critically appraised the growing body of literature on lenticule addition keratoplasty for keratoconus and highlighted its potential as an alternative to penetrating keratoplasty and deep anterior lamellar keratoplasty, although evidence at the time was limited to case series.[57] LIKE combined with CXL has been shown in case series and small prospective observational studies to improve corneal thickness and improve corneal biomechanics while decreasing (and in some cases halting) disease progression in advanced keratoconus.[58][59][60][61]

Corneal Ulcers, Thinning, and Perforations

Case reports have described the successful treatment with SMILE-derived lenticules of recurrent pterygia with critical thinning[62], corneal surface disruptions (e.g., perforations, tears, defects)[63][64][65][66][67], corneal ulcer coverage before definitive management[68], corneal dystrophies[69], and corneal ectasia after refractive surgery.[70][71] Some of these techniques involve the use of fibrin glue for epikeratophakia.

In one study of 22 eyes (14 corneal ulcers, 6 perforations) successful restoration of globe integrity from SMILE-derived lenticules was demonstrated in all cases, with BCVA improvement in 54.5% and maintenance in 40.9% of eyes. No immune rejection was observed.[72]

The application of SMILE-derived glued lenticule patch grafts in corneal ulcers and perforations. (A,B): a single layer of SMILE-extracted lenticule used in corneal ulcers; (C,D): crimped stromal lenticule applied to corneal perforations.[4]

The use of photo-crosslinked dual-network hydrogels based on methacrylated gelatin (GelMA) has also been tested with good results in a rabbit model to allow for lenticular stacking (and customizable allograft thickness and diameter) in the treatment of corneal defects of variable morphology.[73]

Other Applications

The use of SMILE-derived lenticular grafts has shown success in case reports in the treatment of scleral melt[74], superficial limbal dermoid[75][76][77], superficial corneal opacities[78], and as glaucoma tube patch graft coverage.[79][80][81][82] These grafts have shown effectiveness in human and porcine cases for intraocular tamponade for the treatment of recurrent macular holes and macular hole retinal detachments.[83][84] Their use has also been applied in human cases with success in the treatment of optic disc maculopathy.[85]

The use of decellularized SMILE-derived lenticules has also been proposed for use as a suturable limbal epithelial stem cell carrier for the treatment of limbal stem cell deficiency, as potential promoters of corneal stroma regeneration following mechanical corneal injury, and as potential scaffolds for future ocular drug delivery systems.[86][87][88][89][90]

Conclusion

The stromal lenticule procured from SMILE procedures may have clinical benefits in a variety of refractive and corneal conditions, but further research is needed before widespread clinical implementation.

Additional Resources

References

  1. ↑ Moshirfar, M., McCaughey, M. V., Reinstein, D. Z., Shah, R., Santiago-Caban, L., & Fenzl, C. R. (2015). Small-incision lenticule extraction. Journal of cataract and refractive surgery, 41(3), 652–665. https://doi.org/10.1016/j.jcrs.2015.02.006
  2. ↑ Miller SM, Sitto MM, Moin KA, Hoopes PC, Moshirfar M. Comparing The Existing Myopic Keratorefractive Lenticule Extraction (KLEx) Platforms: A Narrative Review. Clin Ophthalmol. 2025;19:2189-2202. doi:10.2147/opth.S532742
  3. ↑ Tan DT, Dart JK, Holland EJ, Kinoshita S. Corneal transplantation. Lancet. May 5 2012;379(9827):1749-61. doi:10.1016/s0140-6736(12)60437-1
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Zhang Y, Li J, Wu Z, Li Y, Wu G, Wei S. The Preservation and Reuse of Lenticules Extracted via Small Incision Lenticule Extraction (SMILE): A Narrative Review. Bioengineering (Basel). Apr 3 2025;12(4)doi:10.3390/bioengineering12040380
  5. ↑ 5.0 5.1 Titiyal JS, Kaur M, Shaikh F, Gagrani M, Brar AS, Rathi A. Small incision lenticule extraction (SMILE) techniques: patient selection and perspectives. Clin Ophthalmol. 2018;12:1685-1699. Published 2018 Sep 5. doi:10.2147/OPTH.S157172
  6. ↑ 6.0 6.1 Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye Vis (Lond). 2014;1:3. doi:10.1186/s40662-014-0003-1
  7. ↑ Liu YC, Pujara T, Mehta JS. New Instruments for Lenticule Extraction in Small Incision Lenticule Extraction (SMILE). Bhattacharya S, ed. PLoS ONE. 2014;9(12):e113774. doi:10.1371/journal.pone.0113774
  8. ↑ Enayati S, Zhou W, Stojanovic A, et al. Effect of femtosecond laser cutting parameters on the results of small-incision lenticule extraction. J Cataract Refract Surg. Nov 1 2022;48(11):1253-1259. doi:10.1097/j.jcrs.0000000000000965
  9. ↑ Lin L, Weng S, Liu F, et al. Development of low laser energy levels in small-incision lenticule extraction: clinical results, black area, and ultrastructural evaluation. J Cataract Refract Surg. Mar 2020;46(3):410-418. doi:10.1097/j.jcrs.0000000000000071
  10. ↑ Yang X, Leng J, Mei Y, et al. Comparison of early clinical and optical quality-related outcomes after SMILE using VisuMax 800 versus VisuMax 500 for myopia and low-to-moderate astigmatism in a Chinese population: a single-center retrospective study. Front Med (Lausanne). 2026;13:1790038. doi:10.3389/fmed.2026.1790038
  11. ↑ Kim BK, Chung YT. Comparison of clinical outcomes following small incision lenticule extraction performed with the visumax 800 versus visumax 500 femtosecond laser. Sci Rep. Jul 15 2025;15(1):25484. doi:10.1038/s41598-025-98041-9
  12. ↑ Yoo TK, Kim D, Kim JS, et al. Comparison of early visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 for myopia: a retrospective matched case-control study. Sci Rep. May 25 2024;14(1):11989. doi:10.1038/s41598-024-62354-y
  13. ↑ Hu J, Bao Y, Wang Z, et al. Comparison of lenticular scanning quality and visual outcomes of keratorefractive lenticule extraction between VisuMax 800 and 500 systems. J Cataract Refract Surg. Feb 26 2026;doi:10.1097/j.jcrs.0000000000001927
  14. ↑ Hyun SY, Moon TH, Magnago T, Arba-Mosquera S, Lim G, Jung MS. Comparison of Low Laser Energy Dose in KLEx: Short-term Clinical Results, Video Analysis, and Histologic Study of Lenticules. J Refract Surg. Apr 2026;42(4):e335-e342. doi:10.3928/1081597x-20260212-03
  15. ↑ Gabrić I, Arba-Mosquera S, Bodakoš K, Bohač M. Effect of Total Laser Fluence on Early and Mid-term Visual and Optical Quality Outcomes After Lenticule Extraction With the SCHWIND ATOS: A Single-Center Study. J Refract Surg. Mar 2026;42(3):e218-e226. doi:10.3928/1081597x-20260112-01
  16. ↑ 16.0 16.1 Bteich Y, Assaf JF, Gendy JE, Awwad ST. Keratorefractive Lenticule Extraction Using the Ziemer FEMTO LDV Z8 Platform (CLEAR): One-Year Results. J Refract Surg. Nov 2024;40(11):e898-e905. doi:10.3928/1081597x-20241016-01
  17. ↑ 17.0 17.1 17.2 Leccisotti A, Fields SV, De Bartolo G. Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application. Cornea. Oct 1 2023;42(10):1247-1256. doi:10.1097/ico.0000000000003123
  18. ↑ Järvenpää JJ. Q-value individualized CLEAR lenticule extraction preserves corneal asphericity and minimizes spherical aberration while maintaining optical zone predictability. Sci Rep. Aug 19 2025;15(1):30470. doi:10.1038/s41598-025-16271-3
  19. ↑ Sachdev MS, Shetty R, Khamar P, et al. Safety and Effectiveness of Smooth Incision Lenticular Keratomileusis (SILK(TM)) Using the ELITA((TM)) Femtosecond Laser System for Correction of Myopic and Astigmatic Refractive Errors. Clin Ophthalmol. 2023;17:3761-3773. doi:10.2147/opth.S432459
  20. ↑ Ozkan J, Shroff R, Arora R, et al. Real-World Study Assessing the Efficacy and Safety of a Novel KLEx Procedure with a Next-Generation Femtosecond Laser for Refractive Error Correction. Clin Ophthalmol. 2026;20:580385. doi:10.2147/opth.S580385
  21. ↑ Moshirfar M, Tukan AN, Bundogji N, et al. Ectasia After Corneal Refractive Surgery: A Systematic Review. Ophthalmol Ther. 2021;10(4):753-776. doi:10.1007/s40123-021-00383-w
  22. ↑ Amaral DC, Menezes AHG, Vilaça Lima LC, et al. Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis. Clin Ophthalmol. 2024;18:865-879. doi:10.2147/opth.S451232
  23. ↑ Mazzotta C, Gagliano C, Borroni D, et al. Crosslinking for post refractive surgery ectasia: application and clinical outcomes. Graefes Arch Clin Exp Ophthalmol. Dec 2025;263(12):3461-3470. doi:10.1007/s00417-025-06968-6
  24. ↑ Wang LX, Deng YP, Xie MZ, et al. Stromal lenticule addition keratoplasty with corneal crosslinking for corneal ectasia secondary to FS-LASIK: a case series. Int J Ophthalmol. 2024;17(3):596-602. doi:10.18240/ijo.2024.03.24
  25. ↑ Zhang S, Yan Y, Shen Z, et al. Development of risk prediction model for small incision lenticule extraction. Front Med (Lausanne). 2025;12:1518889. doi:10.3389/fmed.2025.1518889
  26. ↑ Nemcokova M, Dite J, Klimesova YM, Netukova M, Studeny P. Preservation of corneal stromal lenticule: review. Cell Tissue Bank. 2022;23(4):627-639. doi:10.1007/s10561-021-09990-0
  27. ↑ Shang Y, Li Y, Wang Z, Sun X, Zhang F. Risk Evaluation of Human Corneal Stromal Lenticules From SMILE for Reuse. J Refract Surg. Jan 1 2021;37(1):32-40. doi:10.3928/1081597x-20201030-03
  28. ↑ 28.0 28.1 28.2 Liu YC, Williams GP, George BL, et al. Corneal lenticule storage before reimplantation. Mol Vis. 2017;23:753-764.
  29. ↑ Bievel-Radulescu R, Ferrari S, Piaia M, et al. Banking of post-SMILE stromal lenticules for additive keratoplasty: A new challenge for eye banks? Int Ophthalmol. Aug 25 2024;44(1):355. doi:10.1007/s10792-024-03283-7
  30. ↑ Liang G, Wang L, Pan Z, Zhang F. Comparison of the Different Preservative Methods for Refractive Lenticules following SMILE. Curr Eye Res. Aug 2019;44(8):832-839. doi:10.1080/02713683.2019.1597890
  31. ↑ Xia F, Zhao J, Fu D, et al. Comparison of the Effects of Temperature and Dehydration Mode on Glycerin-Based Approaches to SMILE-Derived Lenticule Preservation. Cornea. Apr 1 2022;41(4):470-477. doi:10.1097/ico.0000000000002846
  32. ↑ Zhang Z, Sun B, Xia F, et al. Study on the biological properties of SMILE-derived corneal stromal lenticules after long-term cryopreservation in nutrient capsules. Exp Eye Res. Feb 2024;239:109756. doi:10.1016/j.exer.2023.109756
  33. ↑ Zhao J, Zhang Z, Xia F, et al. Nutrient capsules maintain tear film homeostasis for human corneal lenticule transplantation. Chemical Engineering Journal. 2022/12/15/ 2022;450:138078. doi:https://doi.org/10.1016/j.cej.2022.138078
  34. ↑ Vautier A, Bourges JL, Gabison E, et al. An Efficient Technique for the Long-term Preservation of SMILE Lenticules Using Desiccation. J Refract Surg. Jul 2023;39(7):491-498. doi:10.3928/1081597x-20230609-01
  35. ↑ Fan Y, Hu X, Zhou X, Li M. A Pilot Study of Lyophilized Decellularized Storage of SMILE-Derived Lenticules. J Refract Surg. Jun 2025;41(6):e542-e550. doi:10.3928/1081597x-20250417-04
  36. ↑ Zhang H, Deng Y, Li Z, Tang J. Update of Research Progress on Small Incision Lenticule Extraction (SMILE) Lenticule Reuse. Clin Ophthalmol. 2023;17:1423-1431. doi:10.2147/opth.S409014
  37. ↑ Riau AK, Liu YC, Yam GHF, Mehta JS. Stromal keratophakia: Corneal inlay implantation. Prog Retin Eye Res. Mar 2020;75:100780. doi:10.1016/j.preteyeres.2019.100780
  38. ↑ Moshirfar M, Shah TJ, Masud M, et al. A Modified Small-Incision Lenticule Intrastromal Keratoplasty (sLIKE) for the Correction of High Hyperopia: A Description of a New Surgical Technique and Comparison to Lenticule Intrastromal Keratoplasty (LIKE). Med Hypothesis Discov Innov Ophthalmol. 2018;7(2):48-56.
  39. ↑ Moshirfar M, Shah TJ, Masud M, et al. A Modified Small-Incision Lenticule Intrastromal Keratoplasty (sLIKE) for the Correction of High Hyperopia: A Description of a New Surgical Technique and Comparison to Lenticule Intrastromal Keratoplasty (LIKE). Med Hypothesis Discov Innov Ophthalmol. Summer 2018;7(2):48-56.
  40. ↑ Keskin Perk FFN, Taneri S, Tanriverdi C, Haciagaoglu S, Karaca ZY, Kilic A. Increasing depth of focus with allogeneic presbyopic inlays: 3-year results. J Cataract Refract Surg. Oct 1 2023;49(10):1005-1010. doi:10.1097/j.jcrs.0000000000001270
  41. ↑ Williams GP, Wu B, Liu YC, et al. Hyperopic refractive correction by LASIK, SMILE or lenticule reimplantation in a non-human primate model. PLoS One. 2018;13(3):e0194209. doi:10.1371/journal.pone.0194209
  42. ↑ Pradhan KR, Reinstein DZ, Carp GI, Archer TJ, Gobbe M, Gurung R. Femtosecond laser-assisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor. J Refract Surg. Nov 2013;29(11):777-82. doi:10.3928/1081597x-20131021-07
  43. ↑ Sun L, Yao P, Li M, Shen Y, Zhao J, Zhou X. The Safety and Predictability of Implanting Autologous Lenticule Obtained by SMILE for Hyperopia. J Refract Surg. Jun 2015;31(6):374-9. doi:10.3928/1081597x-20150521-03
  44. ↑ Brar S, Ganesh S, Sriganesh SS, Bhavsar H. Femtosecond Intrastromal Lenticule Implantation (FILI) for Management of Moderate to High Hyperopia: 5-Year Outcomes. J Refract Surg. Jun 2022;38(6):348-354. doi:10.3928/1081597x-20220503-01
  45. ↑ Moshirfar M, Hopping GC, Somani AN, et al. Human allograft refractive lenticular implantation for high hyperopiccorrection. J Cataract Refract Surg. Feb 2020;46(2):305-311. doi:10.1097/j.jcrs.0000000000000011
  46. ↑ Zhang J, Zhou Y. Small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism. PLoS One. 2021;16(9):e0257667. doi:10.1371/journal.pone.0257667
  47. ↑ Zhang X, Wang X, Cheng C, et al. Short-Term Observation of Refractive Predictability and Corneal Thickness Change After Femtosecond Laser-Assisted Lenticule Intrastromal Keratoplasty and Small-Incision Lenticule Intrastromal Keratoplasty for Correcting Moderate to High Hyperopia. Cornea. Mar 1 2026;45(3):288-296. doi:10.1097/ico.0000000000003842
  48. ↑ Wang Y, Zheng J, Guo Z, Fang X. Efficacy and safety of small-incision corneal intrastromal lenticule implantation for hyperopia correction: a systematic review and meta-analysis. Front Med (Lausanne). 2024;11:1320235. doi:10.3389/fmed.2024.1320235
  49. ↑ 49.0 49.1 Tomita M, Kanamori T, Waring GOt, et al. Simultaneous corneal inlay implantation and laser in situ keratomileusis for presbyopia in patients with hyperopia, myopia, or emmetropia: six-month results. J Cataract Refract Surg. Mar 2012;38(3):495-506. doi:10.1016/j.jcrs.2011.10.033
  50. ↑ Jacob S, Kumar DA, Agarwal A, Agarwal A, Aravind R, Saijimol AI. Preliminary Evidence of Successful Near Vision Enhancement With a New Technique: PrEsbyopic Allogenic Refractive Lenticule (PEARL) Corneal Inlay Using a SMILE Lenticule. J Refract Surg. Apr 1 2017;33(4):224-229. doi:10.3928/1081597x-20170111-03
  51. ↑ Kilic A, Tabakcı B, Özbek M. Excimer laser shaped allograft corneal inlays for presbyopia: initial clinical results of a pilot study. Clin Exp Ophthalmol. 2019;10:1000820.
  52. ↑ 52.0 52.1 Liu YC, Teo EPW, Ang HP, et al. Biological corneal inlay for presbyopia derived from small incision lenticule extraction (SMILE). Sci Rep. Jan 30 2018;8(1):1831. doi:10.1038/s41598-018-20267-7
  53. ↑ Mastropasqua L, Nubile M, Salgari N, Mastropasqua R. Femtosecond Laser-Assisted Stromal Lenticule Addition Keratoplasty for the Treatment of Advanced Keratoconus: A Preliminary Study. J Refract Surg. Jan 1 2018;34(1):36-44. doi:10.3928/1081597x-20171004-04
  54. ↑ Almodin EM, Ferrara P, Camin FMA, Colallilo JMA. Femtosecond laser–assisted intrastromal corneal lenticule implantation for treatment of advanced keratoconus in a child’s eye. JCRS Online Case Reports. 2018/04/01/ 2018;6(2):25-29. doi:https://doi.org/10.1016/j.jcro.2018.01.004
  55. ↑ Jadidi K, Mosavi SA. Keratoconus treatment using femtosecond-assisted intrastromal corneal graft (FAISCG) surgery: a case series. Int Med Case Rep J. 2018;11:9-15. doi:10.2147/imcrj.S152884
  56. ↑ Jin H, He M, Liu H, et al. Small-Incision Femtosecond Laser-Assisted Intracorneal Concave Lenticule Implantation in Patients With Keratoconus. Cornea. Apr 2019;38(4):446-453. doi:10.1097/ico.0000000000001877
  57. ↑ Liu Y, He Y, Deng Y, Wang L. Lenticule addition keratoplasty for the treatment of keratoconus: A systematic review and critical considerations. Indian J Ophthalmol. Feb 1 2024;72(Suppl 2):S167-s175. doi:10.4103/ijo.Ijo_695_23
  58. ↑ Dong Y, Zhang J, Xu Y, et al. Combined femtosecond intrastromal lenticular implantation and corneal crosslinking to treat advanced keratoconus: a 6-month observation including epithelial remodeling. BMC Ophthalmol. Jun 5 2025;25(1):338. doi:10.1186/s12886-025-04141-5
  59. ↑ Sun XY, Shen D, Chen HX, et al. Corneal surface changes after stromal lenticule addition keratoplasty combined with cross-linking for severe keratoconus. Int J Ophthalmol. 2025;18(6):1003-1010. doi:10.18240/ijo.2025.06.05
  60. ↑ Liu J, Shen D, Sun XY, Zhou K, Wang YN, Wei W. [Short term clinical observation of keratoconus treated with stromal lenticule addition keratoplasty combined with corneal collagen cross-linking]. Zhonghua Yan Ke Za Zhi. Oct 11 2023;59(10):832-837. doi:10.3760/cma.j.cn112142-20221204-00621
  61. ↑ Sinha R, Anjum S, Gupta K, et al. Femtosecond laser-assisted corneal intrastromal negative meniscus lenticule implantation with accelerated collagen crosslinking (FILAC) in advanced keratoconus in Indian eyes: A prospective interventional study. Indian J Ophthalmol. Jul 1 2025;73(7):974-979. doi:10.4103/ijo.Ijo_2139_24
  62. ↑ Pant OP, Hao JL, Zhou DD, Wang F, Lu CW. A novel case using femtosecond laser-acquired lenticule for recurrent pterygium: case report and literature review. J Int Med Res. Jun 2018;46(6):2474-2480. doi:10.1177/0300060518765303
  63. ↑ Chen L, Dong Y, Jiang L, et al. A novel sandwich technique of minimally invasive surgery for corneal perforation. Sci Rep. Nov 12 2024;14(1):27675. doi:10.1038/s41598-024-79376-1
  64. ↑ Bhandari V, Ganesh S, Brar S, Pandey R. Application of the SMILE-Derived Glued Lenticule Patch Graft in Microperforations and Partial-Thickness Corneal Defects. Cornea. Mar 2016;35(3):408-12. doi:10.1097/ico.0000000000000741
  65. ↑ Yang H, Zhou Y, Zhao H, Xue J, Jiang Q. Application of the SMILE-derived lenticule in therapeutic keratoplasty. Int Ophthalmol. Mar 2020;40(3):689-695. doi:10.1007/s10792-019-01229-y
  66. ↑ Ganesh S, Brar S, Chopra R. Lamellar surgeries with SMILE-derived lenticules. Taiwan J Ophthalmol. Jan-Mar 2024;14(1):70-77. doi:10.4103/tjo.TJO-D-23-00171
  67. ↑ Abd Elaziz MS, Zaky AG, El SaebaySarhan AR. Stromal lenticule transplantation for management of corneal perforations; one year results. Graefes Arch Clin Exp Ophthalmol. Jun 2017;255(6):1179-1184. doi:10.1007/s00417-017-3645-6
  68. ↑ Min Klimesova Y, Nemcokova M, Netukova M, et al. Corneal stromal lenticule transplantation for the treatment of corneal ulcers. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. Mar 2024;168(1):55-61. doi:10.5507/bp.2023.004
  69. ↑ Zhao J, Sun L, Shen Y, Tian M, Yao P, Zhou X. Using Donor Lenticules Obtained Through SMILE for an Epikeratophakia Technique Combined With Phototherapeutic Keratectomy. J Refract Surg. Dec 1 2016;32(12):840-845. doi:10.3928/1081597x-20160920-01
  70. ↑ Ganesh S, Brar S, Bowry R. Management of small-incision lenticule extraction ectasia using tissue addition and pocket crosslinking. J Cataract Refract Surg. Mar 1 2021;47(3):407-412. doi:10.1097/j.jcrs.0000000000000335
  71. ↑ Li M, Wei R, Qin B, Chang JSM, Zhou X. Long-term results of allogenic corneal lenticule of hyperopic SMILE for post-LASIK ectasia. iScience. Sep 20 2024;27(9):110689. doi:10.1016/j.isci.2024.110689
  72. ↑ Jiang Y, Li Y, Liu XW, Xu J. A Novel Tectonic Keratoplasty with Femtosecond Laser Intrastromal Lenticule for Corneal Ulcer and Perforation. Chin Med J (Engl). Aug 5 2016;129(15):1817-21. doi:10.4103/0366-6999.186639
  73. ↑ Yi X, Song Y, Chen L, et al. Photocrosslinked dual-network hydrogel for sutureless corneal stromal lenticule lmplantation. Front Bioeng Biotechnol. 2026;14:1764867. doi:10.3389/fbioe.2026.1764867
  74. ↑ Yang J, Li B, Cheng G. Long-term outcomes of corneal intrastromal lenticule transplantation for necrotic scleral melting and glaucoma: A case report. Medicine (Baltimore). Aug 8 2025;104(32):e43490. doi:10.1097/md.0000000000043490
  75. ↑ Jacob S, Narasimhan S, Agarwal A, Agarwal A, Ai S. Combined interface tattooing and fibrin glue-assisted sutureless corneal resurfacing with donor lenticule obtained from small-incision lenticule extraction for limbal dermoid. J Cataract Refract Surg. Nov 2017;43(11):1371-1375. doi:10.1016/j.jcrs.2017.09.021
  76. ↑ Wan Q, Tang J, Han Y, Ye H. Surgical treatment of corneal dermoid by using intrastromal lenticule obtained from small-incision lenticule extraction. Int Ophthalmol. Jan 2020;40(1):43-49. doi:10.1007/s10792-019-01201-w
  77. ↑ Li Z, Cheng Z, Jia Z, Tang Y. Treatment of Corneal Dermoid with Fibrin Glue Boned Multi-Layer Lenticules from Small Incision Lenticules Extraction Surgery: A Preliminary Study of Five Patients. Curr Eye Res. Feb 2025;50(2):132-138. doi:10.1080/02713683.2024.2398121
  78. ↑ Hu SS, Ding H, Meng XY, et al. Treatment of superficial corneal opacities with corneal stromal lenticule obtained through SMILE surgery. Int J Ophthalmol. 2024;17(12):2221-2228. doi:10.18240/ijo.2024.12.09
  79. ↑ Wang Y, Li X, Huang W, et al. Partial thickness cornea tissue from small incision lenticule extraction: A novel patch graft in glaucoma drainage implant surgery. Medicine (Baltimore). Mar 2019;98(9):e14500. doi:10.1097/md.0000000000014500
  80. ↑ Wang Y, Liu J, Huang W, Xu Y, Cheng M, Shen Z. The best thickness of cornea graft from SMILE surgery as patch graft in glaucoma drainage implant surgery. Medicine (Baltimore). May 21 2021;100(20):e25828. doi:10.1097/md.0000000000025828
  81. ↑ Spierer O, Waisbourd M, Golan Y, Newman H, Rachmiel R. Partial thickness corneal tissue as a patch graft material for prevention of glaucoma drainage device exposure. BMC Ophthalmol. Feb 27 2016;16:20. doi:10.1186/s12886-016-0196-2
  82. ↑ Song YJ, Kim S, Yoon GJ. Case series: Use of stromal lenticule as patch graft. Am J Ophthalmol Case Rep. Dec 2018;12:79-82. doi:10.1016/j.ajoc.2018.09.009
  83. ↑ Zhang X, Qiao G, He Y, Jiang H, Liu Y, Tang Z. Corneal stromal lenticule covering technique combined with intraocular tamponade for the treatment of recurrent macular holes and macular hole retinal detachments. BMC Ophthalmol. Dec 6 2025;26(1):18. doi:10.1186/s12886-025-04555-1
  84. ↑ Ruggeri ML, Pelusi L, Nubile M, et al. Feasibility Study of Decellularized Corneal Lenticule in a Porcine Model for Macular Hole Closure. Ophthalmol Ther. Apr 2026;15(4):1539-1550. doi:10.1007/s40123-026-01333-0
  85. ↑ Zhang X, Qiao G, Quan Y, He Y, Jiang H. Corneal stromal lenticule transplantation for the treatment of congenital optic disc pit maculopathy : a case report and review. BMC Ophthalmol. Oct 4 2024;24(1):432. doi:10.1186/s12886-024-03707-z
  86. ↑ Hong H, Huh MI, Park SM, Lee KP, Kim HK, Kim DS. Decellularized corneal lenticule embedded compressed collagen: toward a suturable collagenous construct for limbal reconstruction. Biofabrication. Jul 23 2018;10(4):045001. doi:10.1088/1758-5090/aad1a4
  87. ↑ Surovtseva MA, Krasner KY, Kim, II, et al. Reversed Corneal Fibroblasts Therapy Restores Transparency of Mouse Cornea after Injury. Int J Mol Sci. Jun 27 2024;25(13)doi:10.3390/ijms25137053
  88. ↑ Mastropasqua L, Nubile M, Acerra G, et al. Bioengineered Human Stromal Lenticule for Recombinant Human Nerve Growth Factor Release: A Potential Biocompatible Ocular Drug Delivery System. Front Bioeng Biotechnol. 2022;10:887414. doi:10.3389/fbioe.2022.887414
  89. ↑ Wang Q, Rao J, Zhang M, et al. SMILE-Derived Corneal Stromal Lenticule: Experimental Study as a Corneal Repair Material and Drug Carrier. Cornea. Feb 1 2026;45(2):186-195. doi:10.1097/ico.0000000000003787
  90. ↑ Pelusi L, Hurst J, Detta N, et al. Effects of mesenchymal stromal cells and human recombinant Nerve Growth Factor delivered by bioengineered human corneal lenticule on an innovative model of diabetic retinopathy. Front Endocrinol (Lausanne). 2024;15:1462043. doi:10.3389/fendo.2024.1462043
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