Aborted SMILE due to false plane creation and strategy for subsequent removal based on corneal layered pachymetry imaging

Session Details

Session Title: SMILE

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 17:00

Venue: Room A3, Podium 2

First Author: : D.Reinstein UK

Co Author(s): :    T. Archer   R. Vida   G. Carp              

Abstract Details

Purpose:

To describe a complication of false plane creation during an aborted SMILE procedure and the surgical plan devised for subsequent lenticule removal based on corneal layered pachymetry imaging.

Setting:

London Vision Clinic, London, UK

Methods:

During a primary SMILE procedure to treat -13.00 -1.25 x 40 (20/16-2). During a difficult separation, the instrument slipped past the lenticule side cut in the infero-nasal region. The procedure was subsequently aborted. At 1 month, the patient still had lenticule swelling and a 3 line decrease in CDVA. Based on corneal imaging, a decision was made to create a new small incision. A 3-mm incision was created at the infero-nasal border of the original lenticule. This allowed direct access to the tissue that needed to be separated. The lenticule was carefully separated and successfully removed without further incidence.

Results:

At the 1 month visit, corneal topography showed a regular myopic optical zone and the UDVA was 20/20-1 with a manifest refraction of -0.50 -0.25 x 90 (20/16). This was a slight over-correction relative to an intended target of -1.38 DS. CDVA was not affected. Although there was no clear reason why this complication occurred, the suspected cause was an unusual ring of OBL in the outer 1 mm of the lenticule cut, causing increased resistance and leading to the natural cleavage along a new corneal lamellar plane.

Conclusions:

This case demonstrates interface separation must be closely monitored at all times to avoid creating and/or removing an irregular lenticule. The case also highlights the importance of having access to layered corneal imaging to be able to comprehensively analyze and diagnose postoperative corneal refractive surgery complications. Lastly, it demonstrates the ability and importance to abort a procedure and remove the lenticule at a later time if deemed appropriate.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented