CLEAR Lenticule Extraction for Enhancement After Primary Lenticule Extraction Surgery

Background: We aimed to evaluate the feasibility, safety, and efficiency of Corneal Lenticule Extraction for Advanced Refractive Correction (CLEAR) enhancement performed after primary CLEAR. Methods: Six eyes from five patients underwent enhancement to correct residual myopic error. All procedures were carried out with the low-energy FEMTO LDV Z8 laser platform (Ziemer Ophthalmic Systems AG, Port, Switzerland) equipped with integrated optical coherence tomography enabling precise lenticule positioning. Results: The myopic residual refractive sphere was fully corrected in all cases, with refraction remaining stable over the follow-up period. All eyes showed improvement in uncorrected distance visual acuity after retreatment with CLEAR and achieved 20/20 vision or better at the final follow-up visit. Conclusions: Our results suggest that CLEAR enhancement is a safe and effective option for treating residual myopic refractive error after primary CLEAR, keeping the procedure flapless.