Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes

Beckers, David; Kretz, Florian; Beckers, Lena; Saad, Amr; Klabe, Karsten; Kaymak, Hakan; Kirca, Mücella; Breyer, Detlev

doi:10.3390/jcm15124585

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Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes

by

David Beckers

^1,2,*

,

Florian Kretz

^1,2,*

,

Lena Beckers

^1,2,

Amr Saad

^2,3,4,

Karsten Klabe

^2,5,

Hakan Kaymak

^2,5,

Mücella Kirca

^2,5 and

Detlev Breyer

^2,5

¹

Precise Vision Augenärzte, Osnabrücker Strasse 233, 48429 Rheine, Germany

²

Institution for International Innovative Ophthalmic Surgery, 40212 Düsseldorf, Germany

³

Department of Ophthalmology, Stadtspital Zurich, 8063 Zurich, Switzerland

⁴

Spross Research Institute, 8063 Zurich, Switzerland

⁵

Breyer Kaymak Klabe Augenchirurgie, 40212 Düsseldorf, Germany

^*

Authors to whom correspondence should be addressed.

J. Clin. Med. 2026, 15(12), 4585; https://doi.org/10.3390/jcm15124585 (registering DOI)

Submission received: 16 May 2026 / Revised: 10 June 2026 / Accepted: 11 June 2026 / Published: 12 June 2026

(This article belongs to the Section Ophthalmology)

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Abstract

Purpose: To report intraoperative safety and postoperative complications after small-incision lenticule extraction using the 2 MHz femtosecond platform (SMILE Pro; VisuMax 800) in routine practice. Methods: Retrospective consecutive case series at a single center. All planned SMILE Pro procedures were analyzed (916 eyes from 482 patients). Outcomes included completion rate, intraoperative events, postoperative complications stratified as <3 and >3 months, and retreatment rate. Results: Baseline age was 32.9 ± 6.9 years; average preoperative refraction was −3.60 ± 1.90/−0.87 ± 0.76 D (sphere/cylinder) with best corrected visual acuity of −0.08 ± 0.07 logMAR. Procedures were completed in 911 of 916 eyes (99.45%). Suction loss occurred in six eyes (0.66%); one was completed after redocking, four were converted (two ICL, two femtosecond LASIK) and one did not receive a second procedure. No failed lenticule separations occurred. Retreatment was performed in 14 eyes (1.54%): 11 re-LASIK, 2 ICL, and 1 cataract extraction. Early postoperative events (<3 months) were mainly superficial punctate keratitis (3.51%) and dry eye (1.32%); beyond 3 months, events remained uncommon (dry eye 1.65%, photopsia/halo/glare 0.88%). No severe or sight-threatening complications were observed. Conclusions: SMILE Pro on the VisuMax 800 showed a high completion rate, rare intraoperative disruption, low retreatment, and rare, mostly mild postoperative events. These findings support a favorable early safety profile in routine practice; longer-term follow-up is warranted.

Keywords: : small-incision lenticule extraction; SMILE Pro; femtosecond laser; VisuMax 800; refractive surgery

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MDPI and ACS Style

Beckers, D.; Kretz, F.; Beckers, L.; Saad, A.; Klabe, K.; Kaymak, H.; Kirca, M.; Breyer, D. Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes. J. Clin. Med. 2026, 15, 4585. https://doi.org/10.3390/jcm15124585

AMA Style

Beckers D, Kretz F, Beckers L, Saad A, Klabe K, Kaymak H, Kirca M, Breyer D. Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes. Journal of Clinical Medicine. 2026; 15(12):4585. https://doi.org/10.3390/jcm15124585

Chicago/Turabian Style

Beckers, David, Florian Kretz, Lena Beckers, Amr Saad, Karsten Klabe, Hakan Kaymak, Mücella Kirca, and Detlev Breyer. 2026. "Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes" Journal of Clinical Medicine 15, no. 12: 4585. https://doi.org/10.3390/jcm15124585

APA Style

Beckers, D., Kretz, F., Beckers, L., Saad, A., Klabe, K., Kaymak, H., Kirca, M., & Breyer, D. (2026). Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes. Journal of Clinical Medicine, 15(12), 4585. https://doi.org/10.3390/jcm15124585

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Intraoperative Safety and Postoperative Complications After SMILE Pro: A Retrospective Case Series of 916 Eyes

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