Suction Loss During Small-Incision Lenticule Extraction and Impact on Visual Outcome
Narrative Responses:
Purpose
To describe cases of suction loss during small incision lenticule extraction (ReLEx SMILE) and their subsequent intraoperative management, and the impact on visual outcome in terms of efficacy, predictability and safety.
Methods
Retrospective, single center, multi-surgeon analysis of eyes that had SMILE performed with the VisuMax 500kHz femtosecond laser system (Carl Zeiss Meditec). Cases with suction loss occurring during various stages of SMILE were identified and subsequent surgical management recorded. Preoperative, 3-month postoperative manifest refractions, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) of these cases were documented and compared to similar parameters of uncomplicated SMILE cases performed during the same period.
Results
Suction loss occurred in 9 out of 166 consecutive eyes of SMILE performed (5.42%). 7 eyes had immediate re-docking and applanation and SMILE completed without incident. 1 case was converted to femto-LASIK and another abandoned from a second suction break and LASEK performed 3months later. Overall efficacy index for the suction loss group was 0.92, 100% achieving UCVA of 20/40 or better, and 50% 20/20 or better. The uncomplicated group achieved 0.93(p=0.915), with 100% UCVA 20/40 or better, and 70% 20/20 or better. 83% achieved +/-0.5D of target for both groups. Overall safety indices were 1.15 and 1.07 respectively (p=0.245).
Conclusion
Good visual outcomes are possible in SMILE cases complicated by suction loss, with results comparable to non-complicated cases. Immediate re-docking and applanation of the treatment cone followed by a repeat femtosecond pass is possible in most cases, and the surgery need not be abandoned.