Abstract: Objective To establish the SMILE multi-level progressive teaching method and evaluate its preliminary application effect. Design Retrospective comparative teaching study. Participants A total of 7 surgeons received SMILE training in Fuzhou Southeast Eye Hospital. Among them, the training from 2019 to 2021 was organized and implemented by the clinical application specialist of SMILE equipment supplier, with a total of 5 surgeons (the first group), and 2 surgeons (the second group) received the SMILE multi-level progressive teaching training since April 2022. Methods The multi-level progressive teaching process of SMILE was divided into two parts: theoretical training and skill training. The skill training included two modules: femtosecond laser flap making skills and SMILE operating skills. The operating skills module was further divided into two stages: lens scanning and lens extraction. The whole training process is completed under the real-time guidance of the instructor, mainly clinical cases. Main Outcome Measures Surgical complications and their incidence, naked eye visual acuity and diopter the next day after surgery. Results Following training, the first group completed respective numbers of SMILE surgeries at their respective posts by June 2023: 60, 130, 224, 300, and 320 eyes, with complication rates of 6.67%, 3.85%, 16.1%, 2.3%, and 3.75%, respectively. The second group independently completed 45 and 143 SMILE surgeries, respectively, with complication rates of 0% and 1.39%. In the second group, the overall distribution of spherical and cylindrical mirrors on the next day after SMILE was similar to the early and recent results of the instructor, and the vision results of the next day after SMILE were better than those of the instructor (P=0.048), but there was no significant difference in visual acuity on the next day (P=0.086). Conclusions The SMILE multi-level progressive teaching training can effectively solve the teaching difficulty, shorten the learning curve, and fully guarantee the safety and effectiveness of SMILE. (Ophthalmol CHN, 2024, 33: 387-390)

Key words: femtosecond laser microincision corneal stromal lens extraction, teaching