Risk factors and incidence of suction loss during small incision lenticule extraction (SMILE) in 8493 eyes

Huang, Tian-Ze; Shen, Ling; Yu, Xiaoning; Jin, Haiming

doi:10.1186/s12886-020-01680-x

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…Suction loss may occur during SMILE, leading to various options to continue the procedure or to abort it, possibly shifting to LASIK. [28][29][30] Compared with the Zeiss VisuMax, the Ziemer Z8 suction is applied on the sclera rather than on the cornea and has a double control, resulting in a steady suction but with higher and longer vacuum. 31 The Ziemer Z8 interrupts the treatment when 1 of the 2 vacuum sensors perceives a loss of vacuum.…”

Section: Discussionmentioning

confidence: 99%

Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application

Leccisotti

Fields²,

Bartolo³

2022

Cornea

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The aim of this study was to evaluate a new femtosecond laser application for refractive corneal lenticule extraction with suction control and computerized regulation of centration and alignment (Ziemer CLEAR).Methods: This was a retrospective, consecutive, noncomparative case series study. Patients undergoing CLEAR for spherical equivalent (SE) between 23 and 210 D, evaluating SE, defocus equivalent, refractive astigmatism, visual acuity, and centration at 10 months were evaluated in the study.Results: Fifty-three eyes of 42 patients (mean age 40.4 6 8.6 years) were included, with preoperative SE 25.99 6 1.49 D and mean corrected distance visual acuity (CDVA) of 0.05 6 0.07 logMAR. With no suction losses, an intact lenticule was extracted in all eyes. In 6 eyes, peripheral adhesion was resolved by lenticulerrhexis, and in 1 eye, the incision was opened by a crescent blade. Moderate interface inflammation occurred in 3 eyes. At day 1, in the 42 eyes with uneventful surgery, the mean CDVA was 20/27, whereas in the 11 eyes with extra surgical manipulations, it was 20/36 (P= 0.04). At 10 months, for the 53 eyes, the mean uncorrected distance visual acuity was 0.05 6 0.09 logMAR; in 37 eyes (70%), it was 20/25 or better; and the mean CDVA was 0.04 6 0.06 logMAR. Eight eyes (15%) lost 1 logMAR line. The mean SE was 20.13 6 0.15 D. The mean defocus equivalent was 0.33 6 0.32 D, with 46 eyes (87%) #0.50 D and 52 eyes (98%) #1 D. Refractive astigmatism was #0.50 D in 48 eyes (90%). The efficacy index was 1.00, and the safety index was 0.98. The mean decentration from the corneal vertex was 0.28 6 0.07 mm. Conclusions:The application yielded good predictability, efficacy, and safety. Slower visual recovery was observed after extra surgical manipulations.

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Section: Discussionmentioning

confidence: 99%

Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application

Leccisotti

Fields²,

Bartolo³

2022

Cornea

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“…Shorter treatment times with the new VisuMax 800 may reduce patients’ anxiety and eye movements during surgery, which have been linked to intraoperative complications [ 4 , 11 , 13 , 33 , 35 , 36 ]. Furthermore, the integrated cyclotorsion tracking system (OcuLign) in the VisuMax 800 may eliminate the need for manual readjustment and reduce problems with decentration in the near future [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, SMILE is not without limitations: cases of suction loss have been recorded at variable rates [ 11 – 13 ], and SMILE is still unable to correct higher order aberrations [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Refractive outcomes of small lenticule extraction (SMILE) Pro® with a 2 MHz femtosecond laser

Saad,

Klabe,

Kirca

et al. 2024

Int Ophthalmol

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Purpose To evaluate the initial visual outcomes of Small Incision Lenticule Extraction (SMILE) Pro® using a 2 MHz femtosecond laser (VisuMax 800, Carl Zeiss Meditec) and to assess the efficacy, safety, predictability, accuracy, and complication rate. Methods This retrospective analysis included eyes which underwent the SMILE Pro® procedure using VisuMax 800 femtosecond laser to correct myopia. All surgeries were performed by one surgeon (DB). Follow-up was conducted 3 months postoperatively to evaluate visual outcomes after neuroadaptation, corrected visual acuity (CDVA) and intra- and postoperative complications. Results One hundred and fifty-two eyes of 82 patients (mean age 31 ± 6 years) results at 3 months are presented. The mean spherical equivalent (SE) was − 4.44 ± 1.86 D preoperatively while -0.24 ± 0.32 D postoperatively. 99% of eyes achieved SE within ± 1.0 D of attempted correction and 91% were within ± 0.5 D. Efficacy index was 0.93 while the safety index was 1. No complications occurred intra- or postoperatively. No eyes lost more than 1 line of their preoperative CDVA. All highly myopic eyes (− 6.25 to − 10.00 D; n = 18) achieved 20/20 at 3 months postoperatively and were within 0.5 D from the attempted SE and no eyes lost more than 1 line of CDVA. Conclusion The SMILE Pro® is a safe, efficient, and predictable procedure for the treatment of myopia and myopic astigmatism, with comparable results of conventional SMILE surgery. High myopic eyes achieve better results than low and moderate myopia. No complications were recorded in our patients.

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“…Sudden eye movement during a VISUMAX 500 fs laser period of approximately 25–30 s causes suction loss. The incidence of suction loss in the SMILE procedure is approximately 0.4–2.7% 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of early visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 for myopia: a retrospective matched case–control study

Yoo,

Kim,

Kim

et al. 2024

Sci Rep

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VISUMAX 800 was introduced to improve the patient experience and clinical outcomes of small incision lenticule extraction (SMILE). This was a retrospective, matched, and case–control study (1:2) controlled for preoperative central corneal thickness and refractive error that compared early refractive and visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 to treat myopia. We included 50 eyes that underwent the VISUMAX 800 SMILE and 100 eyes that underwent the VISUMAX 500 SMILE. SMILE using VISUMAX 800 was performed using the CentraLign aid for vertex centration. Cyclotorsion was controlled by an OcuLign assistant in the VISUMAX 800 group after corneal marking. Corneal higher-order aberrations (HOAs) were evaluated using a Pentacam 1 month after surgery. No differences were observed in the pre- and post-operative refractive and visual outcomes at 1 day, 1 month, and 6 months after surgery. VISUMAX 800 induced less total HOAs than VISUMAX 500 (P = 0.036). No statistically significant differences were observed in the amounts of induced spherical aberrations or vertical and horizontal comas. No differences were observed in the 1 month and 6 months refractive and visual outcomes between two SMILE procedures, except for VISUMAX 800, which resulted in lower postoperative total HOAs than VISUMAX 500.

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Risk factors and incidence of suction loss during small incision lenticule extraction (SMILE) in 8493 eyes

Cited by 5 publications

References 13 publications

Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application

Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application

Refractive outcomes of small lenticule extraction (SMILE) Pro® with a 2 MHz femtosecond laser

Comparison of early visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 for myopia: a retrospective matched case–control study

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