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  • New technique for lenticule separation improves efficiency of SMILE surgery

    Refractive Mgmt/Intervention

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    The authors of this study describe a new efficient technique to separate the lenticule edge during small incision lenticule extraction (SMILE).

    Study design

    This prospective study evaluated 400 eyes of 400 consecutive myopic (−1.00 to −10.00 D of spherical equivalent, 0 to −4.00 D of cylinder) patients who underwent SMILE by 1 of 2 surgeons. Eyes with poor-quality laser treatment were excluded. One surgeon used the modified technique, whereas the other surgeon used the conventional technique to identify and separate the lenticule edge.

    The modified technique begins with separating half of the cap incision length of the lenticule’s inferior margin from the stromal bed using a hook through the lower end of the cap incision. Next, the head of the hook was set at the left end of the cap incision, jacking the cap margin a little bit and identifying the cap–lenticule interface. Finally, half of the cap incision length of the superior margin of the lenticule was separated from the cap–lenticule interface. A sharp spatula was used to dissect the anterior and posterior surfaces of the lenticule, which was removed through the side incision using forceps.

    Outcomes

    There were 200 eyes each in the modified technique group (group A) and the conventional technique group (group B). The mean lenticule dissection time was 49 seconds in the modified group and 59 seconds in the conventional group (P=0.002). The modified group had a higher rate of complete lenticule dissection in less than 70 seconds (96.5% vs. 86%) and a lower rate of difficult lenticule dissection (3.5% vs. 14%) compared with the conventional group.

    Limitations

    The second eye of the same patient was included, which may skew probability statistics to a smaller true sample population. Different surgeons performed each technique, so the findings do not take into account operator differences.

    Clinical significance

    By using this modified technique, the authors were able to reduce the operation time and complications during SMILE without compromising vision outcomes. This modified lenticule edge dissection technique for SMILE may prove more efficient and effective than conventional methods in identifying the correct dissection plane.