Reapplication Of Small-Incision Lenticule Extraction (Smile) With The Same Surgical Parameters Following Suction Loss During And After Posterior Lenticule Cut

To present the outcomes of two cases of suction loss during and after the posterior lenticule cut in Small-Incision Lenticule Extraction (SMILE) managed by repeating the SMILE procedure (ReSMILE) one week post-operatively with identical surgical parameters.

This is a case series in which we include two cases of suction loss during SMILE in a private ambulatory surgical center for ophthalmology in the Philippines.

The first patient was a 36-year old male with a preoperative manifest refraction of -1.50 sphere with -5.00 cylinder at 180 degrees on the right eye correcting to 20/20. During the application of the femtosecond laser, treatment was interrupted due to suction loss during the lenticule cut. Treatment for the right eye was aborted and planned treatment for the left eye was continued. The patient underwent ReSMILE surgery one week after, where treatment was repeated on the right eye with identical surgical parameters. One week post-operatively ReSMILE, his unaided visual acuity was 20/25, correcting to 20/20 with -0.25 cylinder at 90 degrees. Anterior segment ocular coherence tomography (AS-OCT) was similar to the other eye.

The second patient was a 26-year old male with a preoperative manifest refraction of -6.25 sphere with -1.00 cylinder at 180 degrees on the left eye correcting to 20/20. Suction loss was encountered twice on the left eye after an unremarkable SMILE on the right eye. Initial suction loss occurred during the anterior cap creation, for which docking and femtosecond laser application was repeated immediately. The second suction loss occurred after the creation of the posterior lenticule cut. The SMILE procedure for the left eye was aborted and the patient underwent ReSMILE surgery one week after using the same surgical parameters. One month post-operatively, the patient’s unaided visual acuity is 20/20 with a plano refraction. AS-OCT was similar to the other eye.

Suction loss may occur during any stage of the lenticule creation. It seems ReSMILE without adjusting surgical parameters is a viable option to manage suction loss even after the lenticule cut has been started or created. An interval of one week was suffice to allow the air cavitations created by initial SMILE procedure to dissipate and no problems were encountered on redocking and reapplication of the femtosecond laser for these two cases. ReSMILE resulted in similar visual acuity, refractive results and AS-OCT results when compared to the eye of the same patients that did not encounter suction loss.