‘Pillars Of Strength’ (Post) For An Easier Smile

SMILE (Small Incision Lenticule Extraction) has a steep learning curve and may be associated with various complications which are more common during the learning phase or extraction of thin lenticules. We present an easy to follow nuanced surgical technique for more controlled and safer lenticule dissection which is helpful for beginners. 

At a tertiary care centre in New Delhi. The technique was described by one experienced surgeon and followed up by three novice surgeons.

Surgeon initiates anterior plane dissection from the left half of the incision for right eye and extends the plane of dissection on either side progressively freeing the anterior plane by side to side/ rotatory motion till 6'o clock, ultimately leaving two pillars of strength intact on both sides. The posterior lamellar dissection is then initiated in right half of the incision. The dissection is sequentially extended laterally on either side with back and forth linear motions rather than side to side or rotatory movements and superonasal and superotemporal pillars are left. Pillars dissected in the end by mutiple sweeping motions. This technique is helpful even if posterior plane is completely dissected first inadvertently.

This technique was used in 10 patients (20 eyes). 7 patients (14 eyes) by an experienced surgeon and 3 patients (6 eyes) by novice surgeons. There were 2 eyes in which inadvertently the posterior plane was dissected completely first. The mean age of the patients was 23.6 ± 2.4 years. The mean spherical equivalent (SE) was -3.10 ± 1.74 D. The minimum lenticule thickness was 33 µm and the maximum lenticule thickness was 89 µm. The mean time for lenticule dissection and extraction after laser application was 95.16 ± 15.50 seconds. All the lenticules were intact and complete, with no tears or folds seen during dissection and extraction. The mean log MAR uncorrected visual acuity (UCVA) was 0.0 on the first post-operative day

Our ‘pillars of strength’ technique can be helpful for beginners as retaining intact side pillars on both sides of the plane of dissection provides an anchoring support facilitating more controlled dissection by preventing premature movement, folding or crumpling of the lenticule. This technique facilitates easier and safer dissection in both thin and thick lenticules and is equally useful for safe lenticule separation in cases where inadvertently the posterior plane has been dissected completely first.