Rescue Technique If Lenticule Tear Happens In Lenticular Intrastomal Surgery (Smile)

To decribe the Rescue technique for removing Lenticule remnant if Lenticule tear happens during Lenticular Intrastomal Surgery

Opegra UK Limited Refractive Practice

Young Myope low myopia -1.50 Diopers sphere for SMILE

Young Myope 24 year old  RE-1.50 diopetersSph/-0.50 DCyl LE -1.50 Diopetrs Sph/-0.50 D cyl planned for Bilateral Small Incison Lenticule extraction.

Intraoperative planes identified,Thin and sticky lenticule with few translucent areas in centre on Bubble patttern.

challenging dissection  during removal through forceps Inferior one third of lenticule tear happened. Further lenticulorhexis was not  attempted to avoid further small tears. the delivered lenticule secured safely.

Using blunt dissector, and  gentle sweeping motions   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.

• Lenticule tear can happen in lenticule extraction refractive surgery, particularly in low myopes with thin lenticule if there are sticky /strong adhesions.
• Take your time to ensure complete dissection in both planes upto the periphery.
• Avoid repeated manipulations using forceps as it increases the chances of tear of remaining lenticule along with risk of incision tear.
• If TEAR HAPPENS, AVOID FURTHER TRACTION WITH FORCEPS
• Swipe gently over the lenticule remnant and then below the remnant with gentle sweeping motions in both the planes.
• This cleaves the lenticule from attachments and is a rescue technique.
• Its is important to align the torn pieces together on Cornea(jigsaw puzzle) to ascertain complete removal