SMILE SURGERY COMPLICATIONS RETAINED LENTICULE

To demonstrate the Successful management of torn lenticule during Small Insion Lenticule Extraction (SMILE)Surgery 

Optegra PVT LTD MANCHESTER

Young Myope 24 year old  RE-3.50 diopetersSph/-0.50 DCyl LE -2.50 Diopetrs Sph/-0.50 D cyl planned for Bilateral Small Incison Lenticule extraction.

Intraoperative anterior and posterior planes identified, dissection completed and  lenticule removal attempted through forceps . When inregrity was checked after the extraction,inferior one third of lenticule  was found  missing due to possible  lenticule tear happened while removing through forceps. Further lenticulorhexis was not  attempted to avoid further small tears.

The 2/3delivered lenticule was secured safely.

Using blunt dissector, with a gentle sweeping motion superiorly the remaining lenticule was unfolded and very delicate dissectuon into the anterior and posterior planes performed cleaving the lenticule completely from the inferior attachments.

The free Lenticule delivered out carefully through the incision and zig saw puzzle of lenticule completed to ascertain the total complete removal.

The interface was irrigated to minimise the inadvertent implantation of any epithelial cells.

Day 1 Post Operatively vison was 6/6 in bothe eyes 

Lenticule tear can happen in lenticule extraction refractive surgery, particularly in low myopes with thin lenticule if the dissection is not complete to the periphery with strong adhesions.

Repeated manipulations using forceps to deliver the remaoning lenticule should be avoided as it increases the chances of tear of remaining lenticule along with risk of incison tear.

Gentle blunt dissection with sweeping motions in both the planes should be performed and is a rescue technique which frees up the lenticule and  minimises the manipulations (which are much more with Forceps)thereby maximising the visual outcomes.

Its is important to align the torn pieces together on Cornea(jigsaw puzzle) to ascertain complete removal .