Management of Difficult Lenticule Extraction in the Learning Curve of SMILE

This video describes intraoperative complications encountered during lenticule dissection and extraction in the initial learning curve of small-incision lenticule extraction (SMILE), and their management.

In Case 1, inadvertent posterior plane dissection before separating the anterior plane resulted in cap-lenticular adhesion. The procedure was abandoned and flap-based retreatment at later date was planned.

In Case 2, anterior segment OCT was used to diagnose the retained lenticule with wrong dissection plane and Sinskey hook-assisted extraction of the lenticule was performed in the same sitting.

Case 3 demonstrates incomplete lenticule removal with retained fragments in a case with difficult lenticule dissection and forceful extraction of the lenticule.

Cases 4 and 5 show side-cut tears and cap tears resulting from vigorous manipulations in cases with difficult dissection. Delayed visual recovery was observed; however, eventual visual and anatomical outcomes were satisfactory.