Impact of Pre-Suction Corneal Contact Area on Postoperative Refractive Outcomes in SMILE Surgery: A Retrospective Study

Xiying Tan,* Qing Shao,* Jinfeng Cai, Xia Li Department of Refractive Surgery, Shanghai Aier Eye Hospital, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xia Li, Department of Refractive Surgery, Shanghai Aier Eye Hospital, Wuzhonglu 83, Shanghai, 200235, People’s Republic of China, Tel +86 13816957393, Email [email protected] Jinfeng Cai, Department of Refractive Surgery, Shanghai Aier Eye Hospital, Wuzhonglu 83, Shanghai, 200235, People’s Republic of China, Tel +86 13816957393, Email [email protected]: To investigate the relationship between corneal contact area before suction initiation and postoperative refractive outcomes in SMILE surgery.Methods: A retrospective study was conducted in the refractive department of Shanghai Aier Eye Hospital. Eligible patients who underwent SMILE surgery between January and May 2023 were included. Preoperative and postoperative visual acuity and refractive outcomes were assessed at 1 and 3 months. The pre-suction corneal contact area was quantified using Adobe Photoshop.Results: A total of 53 patients (28 males, 25 females; mean age, 25 years) were enrolled. A significant positive correlation was found between the pre-suction corneal contact area and postoperative refraction (Spearman’s r = 0.65, p < 0.05). Receiver operating characteristic (ROC) curve analysis indicated an area under the curve (AUC) of 0.803 (Std. Error = 0.066, p = 0.001), indicating good predictive ability for overcorrection, with the optimal threshold identified at 70%.Conclusion: Pre-suction corneal contact area plays a critical role in the refractive outcomes of SMILE surgery. Optimizing this parameter may reduce the risk of overcorrection and enhance surgical precision and patient satisfaction.Keywords: SMILE, refractive surgery, corneal biomechanics, corneal contact area