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    AAO 2019 Video Program
    Excimer Laser Surgery , Refractive Mgmt/Intervention

    We describe different stages at which suction loss may be encountered during small-incision lenticule extraction (SMILE) and their management. In case 1, suction loss was observed during lenticule cut. As more than 10% lenticule cut had been completed, SMILE could not be restarted and the case was converted into a flap-based ablative procedure. In case 2, lenticule cut and lenticule side-cut were completed uneventfully. Suction loss was observed during cap cut. The patient was redocked, and the procedure was restarted from point of suction loss in rescue mode. SMILE was completed. In case 3, partial peripheral suction loss was observed beyond the treatment zone during cap cut and cap side-cut. Laser application was continued, and SMILE could be completed uneventfully. Visual and anatomical outcomes were satisfactory in all cases.