Surgical Management Of Retained Lenticule With Multiple False Planes, Following A Complicated Smile Procedure

To report a case of complicated SMILE surgery resulting in incomplete lenticule dissection and retention, and to describe the subsequent therapeutic interventions and visual outcomes.

Private Practice Academic Unit Reinstein Vision, London Vision Clinic, EuroEyes Group, UK

A 29-year-old male was referred after prior SMILE for myopia. Manifest refraction OD was -14.50 -6.00 × 30 with CDVA 20/63. Examination revealed an irregular, edematous retained lenticule with false planes and incomplete separation. High-resolution B-scan imaging of the cornea was performed using the MS39 (CSO, Italy) to map the retained lenticule. A 3 mm inferonasal sidecut incision was created, and the lenticule was carefully dissected under intraoperative OCT guidance (ARTEVO 800, Carl Zeiss Meditec). Postoperative follow-up over 11 months included visual acuity, manifest refraction, corneal topography, and patient-reported visual function. Two months after lenticule removal, refraction improved to +3.00 -1.75 × 78 with CDVA 20/40, although irregular topography persisted. After demonstration of corneal stability at 4 months, combined trans-epithelial PTK and PRK were performed to improve corneal surface regularity and visual quality. At 11 months, refraction stabilized at +1.75 -0.75 × 85 with CDVA 20/20. The patient reported substantial subjective improvement, including marked reduction in haloes and other visual disturbances.

Careful OCT-guided lenticule dissection followed by PRK and TE-PTK can restore visual acuity and improve corneal regularity in retained lenticule after complicated SMILE. Long-term monitoring is essential to optimize refractive outcomes and patient satisfaction.