Suction stability management in small incision lenticule extraction: incidence and outcomes of suction loss in 4000 consecutive procedures

Abstract

Purpose: To report the incidence and outcomes of suction loss during small incision lenticule extraction (SMILE). Methods: The incidence of suction loss was measured over 4000 consecutive SMILE procedures and categorized by cause, the interface in which suction was lost and management (restart/continue SMILE, re-SMILE thinner cap, convert to laser in-situ keratomileusis [LASIK]). One-year outcomes were compared to the fellow eye where no suction loss occurred. Results: There were 20 cases of suction loss (0.50%): during the lenticule interface in seven eyes, lenticule side cut in one eye, cap interface in nine eyes and small incision for three eyes. Small incision lenticule extraction (SMILE) was continued in seven eyes, thinner cap SMILE in four eyes, LASIK in eight eyes, and the small incision was manually completed in one eye. Suction loss was caused by a Bell's reflex in 10 eyes, fixation light tracking in six eyes, patient anxiety in two eyes, a nociceptive reflex in one eye and false suction in one eye. There was no difference in results for suction loss and fellow eyes, respectively: uncorrected distance visual acuity was 20/20 or better in 100% in both groups, spherical equivalent was within AE0.50 D in 85% and 79%, one line loss of corrected distance visual acuity in 5% and 0%, and no eyes lost two lines. Conclusion: Suction loss can be managed depending on the interface during which suction is lost. Treatment was completed on the same day in all instances. Visual and refractive outcomes were unaffected compared to the fellow eye in this series. PatientsThis was a retrospective non-comparative case series of all myopic SMILE e72 Acta Ophthalmologica 2020

Risk Factors and Incidence of Suction Loss during Small Incision Lenticule Extraction (SMILE) in 8487 eyes

“…In our study, suction loss in 19 (61.3%) eyes occurred during the cap interface stage and 8 (25.8%) during the creation of small incision. The respective numbers were 45% and 15% as reported by Reinstein [7] and 51% and 3% as reported by Liu [13]. One possible explanation for this phenomenon is that the air bubbles generated from lenticule cutting obscure the patient's vision.…”

“…A review by Reinstein reported that the average global incidence of suction loss during SMILE surgery is 0.72% [7]. In studies involving large population of more than 1000 cases, the reported incidence of suction loss ranges from 0.17-2.10% [4,7,9,11,[13][14][15]. As doctors become more experienced, the incidence of suction loss decreases.…”

“…The e cacy, safety, predictability, and stability of SMILE have been supported by many clinical studies [1][2][3]. However, intraoperative and postoperative complications can still be observed [4][5][6][7][8]. The possible complications of SMILE surgery include suction loss, di culty or inability to extract the lenticule, and abrasion or minor tears in the small incision [9,10].…”

SMILE – Small Incision Lenticule Extraction

“…Wenn den empfohlenen Maßnahmen gefolgt wird, sind die visuellen Ergebnisse nach einem Vakuumverlust nicht beeinträchtigt [28].…”

Risk Factors and Incidence of Suction Loss during Small Incision Lenticule Extraction (SMILE) in 8493 eyes

“…However, intraoperative and postoperative complications can still be observed [3][4][5][6][7]. The possible complications of SMILE surgery include suction loss, di culty or inability to extract the lenticule, and abrasion or minor tears in the small incision [8,9].…”