A Novel Irrigation Technique To Prevent Blood Entry In Klex Interface

To describe and evaluate a novel incision irrigation technique that prevents blood from entering the lenticule interface in KLEx in patients undergoing SmartSight lenticule extraction surgery with the Schwind ATOS femtosecond laser.

This clinical study was conducted at the Muscat Eye Laser Center, a private ophthalmic surgery center in Muscat, Oman.

A total of 2,091 eyes underwent KLEx with the ATOS femtosecond laser. Among them, 15 eyes (0.71%) experienced bleeding at the incision site. The first six consecutive cases (control group) were managed by irrigating the interface with balanced salt solution (BSS) only after lenticule extraction. The last nine consecutive cases (new technique group) underwent continuous incision irrigation with BSS from the moment bleeding was observed until lenticule extraction was completed. All cases were performed using a 9 mm cap diameter, a 2 mm incision at 130°, and treatment centration on the corneal vertex. The primary outcome measures were surgical time and interface clarity.

In the control group (6 eyes), the mean surgical time from incision opening to interface clearance was 219 seconds, requiring additional BSS irrigation to remove blood from the interface. In contrast, the new technique (9 eyes) significantly reduced surgical time to 88 seconds (p<0.05) by preventing blood from entering the lenticule interface, eliminating the need for additional irrigation. No corneal edema, interface haze, or adverse clinical effects were observed.

Continuous incision irrigation with BSS is a simple, effective, and safe method to prevent blood from entering the lenticule interface in KLEx. This technique reduces surgical time, minimizes the need for additional interface manipulation, and decreases the risk of complications associated with excessive cannula use inside the interface, as well as those related to blood particles in the lenticule interface.