Posters

Early identification and management of black spots to prevent false passage creation in small-incision lenticule extraction (SMILE)

Poster Details

First Author: D.Agius MALTA

Co Author(s):    F. Mercieca                    

Abstract Details

Purpose:

This paper aims to raise awareness on the importance of early black spot recognition which is not uncommon in anterior and posterior dissection during SMILE. It is well known that these, together with opaque bubble layers are causes for false plane creation that may result in an unsuccessful refractive outcome. Furthermore, this paper challenges the concept of aborting the procedure in cases of extensive black spots by explaining the intraoperative surgical modification that allows for adequate dissection in one sitting.

Setting:

A collection of three black spot SMILE cases that could have potentially been complicated with false passage creation were encountered, managed in one sitting and recorded. The cases in question have been selected from Mr Franco Mercieca's refractive surgery practice at St James' Eye Clinic.

Methods:

Four cases with black spot formation after femtosecond laser were encountered. One of the such shows the formation of false passage creation by swiping through a tough adhesion. The other three demonstrate early recognition of black spot formation and the subsequent management to complete the surgery. The position of such adherent areas was memorised and during dissection, a cautious approach was implemented in sensing a hard stop, downward direction and no progress after a few swipes. The dissector was thus swiped around the adherent section, either from the lateral aspect or inferior to it.

Results:

The authors demonstrate the intraoperative surgical technique through alteration that ensured good visual recovery after four successfully completed one-sitting black spot SMILE procedures. Videos of the above procedures accompanied by explanatory diagrams have been created to explain this useful technique.

Conclusions:

The authors describe a case based proven method that could prevent false passage formation in the black spot scenario, thus preventing secondary surgery requirement and poor visual outcome in SMILE surgery. The main learning points include: 1. Early recognition of black spots of significant size and position. 2. Memorising the position of such black spots 3. Careful dissection at their proximity 4. Swiping around the lateral or inferior aspect of the spots

Financial Disclosure:

None