Complications related to learning curve

Inability to detect the edge of the lenticule is a major cause

Dermot McGrath

Posted: Friday, September 20, 2019

Ahmed El Shahed MD

Most of the intraoperative complications encountered in small-incision lenticule extraction (SMILE®) procedures seem to be related to initial surgical inexperience with the technique, according to a study presented at the Free Paper Forum at the 37th Congress of the ESCRS in Paris, France.

“We think that the inexperience of the surgeon at the beginning of the learning curve, and in particular the inability to detect the edge of the lenticule with numerous attempts of dissection above or below the lenticule, is the major cause of most intraoperative complications,” said Ahmed El Shahed MD.

Dr El Shahed presented the results of 282 eyes of 141 patients who underwent SMILE surgery for myopia and/or myopic astigmatism at Ebsar Eye Center, Benha, Egypt.

Suction loss was found to be the biggest complication, occurring in 18 eyes (6.38%), followed by treatment decentration in 6 eyes, wound bleeding in 21 eyes, incomplete bubble separation in 3 eye and epithelial defects in 15 eyes.

In cases where suction was lost before the total creation of the lenticule, the procedure could be aborted and rescheduled after the reabsorption of the cavitation bubbles, said Dr El Shahed.

“If the lost suction occurred after the total creation of the lenticule or during the creation of the cap, the eye could be re-docked with a repair license if it was available and the surgeon could restart the cap, side cut and wound creation and dissect it normally,” he added.