Intraoperative Complications During Small Incision Lenticule Extraction Learning Curve
Purpose
To record the surgical difficulties and intraoperative complications that happen during the early learning curve of small incision lenticule extraction.
Methods
A retrospective non comparative study that included 256 eyes subjected to myopia correction by SMILE technique. We recorded the intraoperative complications done by single refractive surgeon during his learning curve.
Results
Suction failure during docking occurred in 38 eyes. Retreatment in the same setting after suction failure were done in 19 eyes and 9 eyes were converted to flap treatment while 10 eyes treatment was aborted and postponed to another setting. Small tear (<2mm) at the incision site occurred in 11 eyes while large tear (>2mm) in 3 eyes. Difficult identification of dissection planes with dissection below the lenticule before above occurred in 42 eyes. Difficult lenticular dissection in 17 eyes due to energy insufficiency. Missing part of the lenticule occurred in one eye. Bleeding into the interface occurred in 2 eyes. Conjunctival suction between the cone and the cornea with interfering with laser treatment occurred in 2 eyes eye. Decentered ablation occurred in 5 cases. No cases of cap perforation.
Conclusion
Many intraoperative complications can occur during the learning curve of SMILE operation and the orientation of these complications can reduce its incidence during conversion to SMILE.