SLIDE 1
Managing suction loss during SMILE
Yusuf YILDIRIM, MD
Beyoglu Eye Training and Research Hospital Cataract And Refractive Surgery Department Istanbul, TURKEY
SLIDE 2 SMILE-Suction Loss
- Incidence 0.5-4.4%
- Decrease with surgical
experience
movement
- Patient anxiety
- Longer duration of
suction
Moshirfar M, McCaughey MV, Reinstein DZ et al. Small‐incision lenticule extraction. J Cataract Refract Surg 2015; 41: 652–665. Wong CW, Chan C, Dan D et al. Incidence and management of suction loss in refractive lenticule extraction. J Cataract Refract Surg 2014; 40: 2002–2010 Clin Ophthalmol. 2018; 12: 665–668. Intraoperative complications of refractive small incision lenticule extraction in the early learning curve J Cataract Refract Surg. 2017 Jun;43(6):796-802.Incidence and management of intraoperative complications during small-incision lenticule extraction in 3004 cases Incidence, management and outcomes of suction loss during SMILE in 4,000 eyes. D.Reinstein et all. ESCRS 2017 Lisbon
SLIDE 3 Our Experience
Suction Loss
Lenticule cut
2 %0.14 Flap cut 8 %0.56 Flap side cut 3 %0.21 Total 13 % 0.91
2012-2018 Total patient 731 Total eyes 1426 Suction Loss in first 100 cases – 8 eyes Suction Loss after first 100 cases – 5 eyes
Learning curve is important
SLIDE 4
Suction Loss
Re-centering to the exact same location is of biggest importance after a SMILE treatment interruption.
If you have suction loss you must stop the procedure
SLIDE 5
SMILE: Incomplete Lenticule Cut – progress <10%
SLIDE 6
SMILE: Incomplete Lenticule Cut – progress >10% (conversion to flap)
SLIDE 7
SMILE: Incomplete Lenticule Side Cut
SLIDE 8
SMILE: Incomplete Cap Cut
SLIDE 9
Suction Loss-Incomplete Cap Cut
SLIDE 10 Has the suction loss impact on vision?
Preoperative Postoperative
UCVA: 0.2 BCVA: 0.9 (-3.75) UCVA: 0.9 BCVA: 0.9
SLIDE 11
SMILE: Incomplete Cap Side Cut
SLIDE 12
Suction Loss-Incomplete Cap Side Cut
SLIDE 13 Has the suction loss impact on vision?
Preoperative Postoperative
UCVA: 0.2 BCVA: 1.0 (-4.50 -0.50 170) UCVA: 1,0 BCVA: 1,0
SLIDE 14 Take home message
- Giving information preoperatively is reduced patient’s anxiety
- If you have suction loss you must stop the procedure
- If it occurs; select appropiate approach (re-suction SMILE or convert to
flap) During SMILE, unexpected problems may occur These problems can be successfully treated with proper approaches
SLIDE 15
Beyoglu Eye Training and Research Hospital
Thank you…
First SMILE in Turkey (23/05/2012)
