What are the ReLEX SMILE laser surgery risks?

ReLEx SMILE is a surgical operation, like all surgical procedures. And the risks of surgery are very low.

The most common risk when performing ReLEX SMILE.

Probably the commonest risk is that during the procedure, when the patient is looking at the little green blinking light, there’s a slight movement of the eye, causing loss of suction. Because the laser provides very gentle suction on the surface of the eye, so gentle you can’t feel it. But if that suction breaks, then the procedure has to be halted. And then the surgeon has to assess whether or not one can proceed that day or not.

In over half the patients, one can start again and proceed. But occasionally that’s not possible, depending on how far advanced during the procedure we are. If, however, we can’t proceed, no harm is done, because all the laser does is place a few bubbles in the eye. And within a few hours those bubbles are gone. So, someone can come back, a couple of weeks, maybe 2-4 weeks later, and then continue the procedure.

So, that’s a very frustrating happening if it occurs, but again, it’s about safety. So, if there’s any doubt that the surgeon can’t proceed on the day, the best thing to do is abort the procedure for safety reasons and come back another day. So, that’s the commonest complication. When surgeons are learning SMILE,
that’s been quoted at 2%. In more experienced hands, it’s much less frequent than that.

The most serious risk if ReLEX SMILE.

The most serious complication of SMILE is potential infection. That’s not yet been reported in SMILE. In laser eye surgery, infection… LASIK in particular, infection can occur. It’s serious but it’s treatable in the vast majority of cases. But to put it in perspective, I’ve been doing laser eye surgery for over 20 years,
and I’ve seen one infection. That patient, we treated, and he did extremely well and made a full visual recovery.

The rarity of these complications occurring.

In contrast, I’ve seen hundreds of contact lens wearers with infections, and many of those don’t do well and can lose vision. And one of the advantages, if you have laser eye surgery, and you feel that the eye is a bit sticky or sore, we have an emergency number, you get in touch with us straight away, we’ll see you… if it’s Saturday, Sunday, bank holiday, it makes no difference. And we can treat the infection promptly. Contact lens wearers often carry on wearing their contact lenses when their eye is a bit sticky, and they can get unusual infections and they can present late. So, the risk of a serious infection is much commoner in a contact lens wearer than with a laser eye surgery patient, or somebody having ReLEx SMILE procedure. Not a complication, but something to consider, with all laser surgery, including ReLEx SMILE, is that there may be a residual spectacle prescription at the end of the procedure, which is bothering a patient. If that happens, the eye can be re-treated to eliminate that prescription.

Patients often say, well if it’s happened once, isn’t it going to happen again? But the fact of the matter is, if you start off with a high prescription, as many ReLEx SMILE patients have, and your prescription is, say, -10, if you’re 10% out, you may end up -1. Which would require a retreatment. If you then treat the -1, and it’s 10% out, you’re left with -0.1, which is insignificant and not noticeable. So, up to 5% of patients may require a retreatment, particularly if they start off with a high prescription.

About the Author

Mr Robert Morris

BSc(Hons), MB BS (Hons), MRCP, FRCS, FRCOphth
Consultant Ophthalmic Surgeon

Robert Morris trained at St Bartholomew’s Hospital part of the University of London. He graduated with Honours in his final examinations. Robert completed his post-graduate ophthalmic training at the renowned units in Oxford Eye Hospital and London’s Moorfields Eye Hospital. Within the NHS, he has had a high volume cataract surgery practice and performed over 12,000 cataract procedures. He has an interest in squint surgery and is a national expert in this field. In addition to his NHS work, Robert manages a successful independent private practice. He continualy updates his training to keep abreast with the latest technology and techniques in refractive surgery.