THE SECOND SURGERY IS NOT A SMALLER FIRST ONE.

Tissue has already been spent, a lamellar plane already exists, and the safety margins are thinner. RLES AI treats retreatment as its own discipline — with stability requirements, a cumulative tissue budget and a decision tree grounded in flap age and technique.

FIRST QUESTION: IS THE EYE EVEN STABLE?

Retreatment planning begins with proof of refractive stability — two refractions at least six weeks apart within 0.50 D, with general practice favouring 6–12 months after the primary procedure — and a meaningful treatment threshold of ≥ 0.50 D. Earlier retreatment is possible but is explicitly recorded as the surgeon’s responsibility, with the literature threshold noted in the report.

THE DECISION TREE, BY FLAP AGE AND TISSUE

• Flap younger than ~2 years with adequate tissue → re-lift is the first choice
• Older flap → surface ablation with mitomycin-C over the flap takes priority (epithelial ingrowth risk rises with late re-lifts)^[1]
• Post-SMILE → CIRCLE cap-to-flap conversion^[3] or thin-flap LASIK above the interface,^[4] cap thickness dependent
• Tissue says no → the phakic ICL pathway opens; the answer is an alternative, not a dead end
• Re-cutting an old flap plane is never proposed — intersecting lamellar planes create scar keratopathy and irregular astigmatism that does not self-resolve

THE BUDGET IS CUMULATIVE

The tissue calculation restarts from the currently measured pachymetry, PTA is assessed cumulatively across both procedures, and all procedure-specific RSB/RCT floors apply unchanged. Published outcome expectations from the enhancement literature^[2] are included for honest patient counselling.

FREQUENTLY ASKED QUESTIONS