ESCRS - PP21.12 - Learning Curve For Small Incision Lenticule Extraction (Smile) Using The Visumax 800 Femtosecond Laser Evaluated By Procedure Time For Consecutive Cases

Learning Curve For Small Incision Lenticule Extraction (Smile) Using The Visumax 800 Femtosecond Laser Evaluated By Procedure Time For Consecutive Cases

Published 2023 - 41st Congress of the ESCRS

Reference: PP21.12 | Type: Free paper | DOI: 10.82333/s2qx-r660

Authors: Joseph Potter* 1 , Dan Reinstein 2 , Timothy Archer 1 , Ruchi Gupta 1

1Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom, 2Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France;Biomedical Science Research Institute,Ulster University,Coleraine,United Kingdom

Purpose

To investigate the learning curve for small incision lenticule extraction (SMILE) using the VISUMAX 800 femtosecond laser by evaluating bilateral procedure time for the first 70 consecutive cases, and the last 20 cases after 1 years’ experience.

Setting

London Vision Clinic, London, UK

Methods

Retrospective analysis of 90 patients who underwent SMILE using the VISUMAX 800 femtosecond laser (Carl Zeiss Meditec) by an experienced SMILE surgeon (DZR). The population included the first 70 consecutive patients (Sept 2021 to Jun 2022), and 20 consecutive patients treated 1 year later (Jan 2023 and Feb 2023). The internal microscope video was reviewed and procedure time was defined as when the contact glass was attached to the treatment cone (start) to when the speculum was removed from the second eye (end). Procedure time was plotted for consecutive cases, with a mean calculated for each group of 10 cases. Procedure time for the 20 most recent SMILE cases by the same surgeon using the VisuMax (500KHz) was also conducted for comparison.

Results

The procedure time decreased over the course of the first 70 cases. The mean procedure time (number <10 minutes, number <9 minutes) for each group of 10 patients was [1] 14:33 (0, 0), [2] 11:28 (1, 0), [3] 10:30 (5, 2), [4] 10:24 (3, 3), [5] 11:06 (1, 0), [6] 09:16 (7, 2), [7] 08:30 (9, 7). The procedure time was lower after 1 years’ experience (350-370th consecutive bilateral cases): 07:57 (20,19). The mean procedure time for SMILE using the VisuMax (500KHz) was slower than that of the VISUMAX 800: 08:29 (19,16).

Conclusions

The learning curve for SMILE using the VISUMAX 800 femtosecond laser, for an experienced VisuMax (500KHz) SMILE surgeon, requires approximately 60 cases to be able to consistently perform a bilateral procedure in <10 minutes. The mean bilateral procedure was time faster for SMILE with the VISUMAX 800 compared to the VisuMax (500KHz).