Management Of Suction Loss During Smartsight Lenticule Extraction In 4,433 Eyes: Incidence, Outcomes, Risk Factors, And Same-Day Recutting Of Refractive Lenticules

To evaluate the incidence, management, clinical outcomes, and risk factors associated with suction loss during SmartSight lenticule extraction, which utilizes an automated eye-tracking system for treating myopia and myopic astigmatism.

First Eye Clinic, Seoul, Republic of Korea.

A retrospective analysis was conducted on 4,433 consecutive eyes that underwent SmartSight procedures. Eyes experiencing suction loss (study group) were compared with those that underwent uneventful SmartSight surgery (control group). Corneal topography, manifest refraction, and uncorrected (UDVA) and corrected (CDVA) distance visual acuity were assessed preoperatively and at postoperative 1 day and 3 months. Potential risk factors contributing to suction loss were identified.

Suction loss occurred in 19 out of 4,433 eyes (0.43%) and was categorized based on the surgical step: refractive lenticule cutting (6 eyes), cap cutting (11 eyes), and cap small incision creation (2 eyes). Surgery was successfully resumed and completed on the same day using a step-by-step approach tailored to each case. No statistically significant differences in logMAR UDVA (P > 0.05) or CDVA (P > 0.05) were observed between the study and control groups. Identified risk factors for suction loss included poor patient cooperation, narrow palpebral fissure, flat cornea, conjunctivochalasis, and short white-to-white distance (P < 0.05).

SmartSight, equipped with an automated eye-tracking system, enables step-by-step procedural adjustments, allowing for the safe continuation of surgery even in cases of suction loss. Consequently, postoperative visual and refractive outcomes remain comparable to those of uneventful SmartSight procedures.