Inferior pseudo-hinge fulcrum technique for LASIK after SMILE and incidence of intraoperative complications

Session Details

Session Title: LASIK vs SMILE

Session Date/Time: Monday 24/09/2018 | 16:30-18:00

Paper Time: 17:24

Venue: Room A3, Podium 2

First Author: : A.Stuart UK

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

Abstract Details

Purpose:

To describe a surgical technique for lifting a LASIK flap when performing a LASIK retreatment after SMILE, and report the incidence of complications in a LASIK after SMILE population.

Setting:

London Vision Clinic, London, UK

Methods:

Retrospective analysis of SMILE retreatments performed as LASIK using the VisuMax femtosecond laser between September 2013 and January 2017. A bimanual inferior pseudo-hinge fulcrum technique was developed to minimize the chance for tearing or entering the small incision when lifting a new LASIK flap. A flap lifter and McPherson’s forceps are inserted into the inferior third of the flap, slightly angled up to avoid perforating through to the SMILE interface. Once inserted the instruments are guided in a standardized method to avoid the SMILE interface while safely separating the new flap. The incidence of intraoperative complications was analysed.

Results:

During the study period, 162 retreatments were performed out of 3,933 primary SMILE treatments (with 1 year maturity); 4.12% retreatment rate. The retreatment was LASIK in 135 eyes, side cut only in 1 eye, and Circle in 3 eyes. The remainder underwent a surface ablation. There was a tear to the small incision in 2 eyes (1.4%). The SMILE interface was accessed in 8 eyes (5.8%), of which 1 was a central tear (0.7%), and 1 resulted in the SMILE interface being lifted (0.7%). There were no complications in the last 84 consecutive procedures (60%) using the finalized technique.

Conclusions:

The bimanual inferior pseudo-hinge fulcrum technique was developed as a response to complications of performing a flap lift in a LASIK retreatment after SMILE. The technique decreases the chance of accessing the SMILE interface or tearing the small incision.

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