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Incidence, management and outcomes of suction loss during SMILE in 4,000 eyes

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Session Details

Session Title: Small Lenticule Extraction

Session Date/Time: Sunday 08/10/2017 | 11:00-12:30

Paper Time: 11:06

Venue: Room 3.6

First Author: : D.Reinstein UK

Co Author(s): :    G. Carp   T. Archer   M. Jukic   E. Rowe           

Abstract Details


To report the incidence, management, and outcomes of suction loss during SMILE for a 4,000 eye population.


London Vision Clinic, London, UK


This was a retrospective review of the population of 4,000 consecutive eyes treated by SMILE at London Vision Clinic using the VisuMax femtosecond laser (Carl Zeiss Meditec). Inclusion criteria were to have undergone SMILE, including the very first eyes treated. The incidence of suction loss was measured and categorized according to the interface during which the suction loss occurred and how the treatment was managed (restart SMILE, re-SMILE thinner cap, switch to LASIK). Patients were followed for 1 year after surgery. Visual and refractive outcomes were compared to the fellow eye where no suction loss occurred.


There were 20 cases of suction loss (0.50%): lenticule interface in 8 eyes (40%), cap interface in 9 eyes (45%), small incision for 3 eyes (15%). SMILE was continued in 7 eyes (35%), thinner cap SMILE in 4 eyes (20%), LASIK in 8 eyes (40%), small incision manually completed in 1 eye (5%). Results for suction loss and fellow eyes respectively were as follows. UDVA 20/20 or better in 94% and 87% of eyes. SEQ was +0.17±0.41D and -0.05±0.47D, 74% and 72% within ±0.50D. One line loss CDVA in 5% and 11% of eyes, but none lost ≥2.


Suction loss during SMILE can be managed depending on the interface during which suction is lost. The treatment was completed in all instances. Visual and refractive outcomes were unaffected by the suction loss compared to the fellow eye.

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

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