Complications of small incision lenticule extraction

Asif, Mohamed Ibrahime; Bafna, Rahul Kumar; Reddy, Jagadesh C; Titiyal, Jeewan S; Maharana, Prafulla K.; Sharma, Namrata

doi:10.4103/ijo.ijo_3258_20

Cited by 16 publications

(13 citation statements)

References 110 publications

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“…Intraoperative complications which have been reported after SMILE include: suction loss, decentering of the treatment, incision tearing or cap perforation, tearing of the lenticule and subsequent retention of some lenticular tissue within the cornea, an opaque bubble layer leading to difficult extraction of the lenticule, uncut areas of the lenticule, lenticule adherence to the cap resulting in a difficult extraction procedure, bleeding at the incision site, and epithelial defects. [4][5][6][7][8][9] Nevertheless, studies of SMILE complications conclude that although some of these complications may temporarily affect visual recovery, most resolve with appropriate treatment, [4][5][6][7][8][9] and the overall frequency of complications in the largest study was 6.8% 8 which is comparable or lower to what would be expected after LASIK. 10 Epithelial ingrowth is a rare postoperative complication after SMILE because the procedure is flapless, and the overall incidence of epithelial ingrowth is lower than after FS-LASIK.…”

Section: Introductionmentioning

confidence: 77%

“…Incisions, side cut tears, epithelial defects, cap rupture and diabetes could all be potential risk factors. 9,[12][13][14] The purpose of this paper is to present a new potential cause of epithelial ingrowth after SMILE: a vertical epithelial gas breakthrough, which creates a fistula between the interface and the epithelium. Vertical epithelial gas breakthrough has previously been reported as a complication of femtosecond LASIK, 15 but to our knowledge, it has not been reported as a complication of SMILE.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New mechanism for epithelial ingrowth after small incision lenticule extraction: Vertical epithelial gas breakthrough

Rojas

Ruibal²

2022

European Journal of Ophthalmology

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A 41-year-old man underwent SMall Incision Lenticule Extraction (SMILE) to treat myopia in both eyes. The femtosecond procedure was uneventful but a paracentral epithelial blister appeared during the dissection of the anterior plane of the lenticule in the right eye. The posterior surface of the lenticule was dissected without any complication. The surgery of the left eye was uneventful. In the postoperative period, he developed a paracentral epithelial ingrowth in his right eye, exactly underneath the site where the epithelial blister had been noted during the dissection of the lenticule. This induced irregular astigmatism, severely affecting his visual acuity. The decision of surgical treatment was made. After the de-epithelialization of an area of 6mm around the ingrowth, the SMILE incision was opened, and the epithelial ingrowth was dissected and removed from the interface. One month later, uncorrected visual acuity was 20/20, no epithelial ingrowth was observed at the interface, and only the edge of the former ingrowth was barely visible in slit lamp examination. No recurrence was observed. We hypothesize that a vertical epithelial gas breakthrough created a fistula between the interface and the epithelium, forming a pathway for the epithelial cells and giving rise to epithelial ingrowth.

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Section: Introductionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New mechanism for epithelial ingrowth after small incision lenticule extraction: Vertical epithelial gas breakthrough

Rojas

Ruibal²

2022

European Journal of Ophthalmology

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“…Varying intraoperative complications specific to SMILE are possible, including difficulty in lenticular dissection or extraction, cap perforation, and decentered centration [1]. Various postoperative problems have been documented, including interface debris, epithelial ingrowth, infectious keratitis, diffuse lamellar keratitis (DLK), and transient light sensitivity syndrome (TLSS) [2].…”

Section: Introductionmentioning

confidence: 99%

Interface Fluid Syndrome Masquerading as Diffuse Lamellar Keratitis After Small Incision Lenticule Extraction

LoBue¹,

Coleman²,

Lam³

et al. 2023

Cureus

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A 34-year-old male with no past medical or ocular history underwent bilateral uncomplicated small incision lenticule extraction (SMILE). On day 1, uncorrected distance visual acuity (UDVA) was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). The intraocular pressure (IOP) was 12 mmHg in both eyes (OU). On day 17, UDVA was 20/70 OD and 20/30+2 OS. Slit-lamp examination (SLE) revealed diffuse 2+ haze at the interface suspicious for diffuse lamellar keratitis (DLK). Topical difluprednate was added twice a day (BID). Vision decreased by day 20 with a significant myopic shift and 3+ interface haze OU. A washout of the interface was performed. Topical steroids were increased with oral prednisone. One day after the washout, vision and interface haze improved. On day 3 status post washout, UDVA decreased to 20/70 OD and 20/50 OS. IOP was 42 mmHg OU. A diagnosis of interface fluid syndrome (IFS) was confirmed. All steroids were stopped while adding ocular hypotensive medication. One month later, visual acuity was 20/20 OU with a complete resolution of interface haze.Only a handful of IFS has been documented in SMILE, an incidence that may increase as SMILE becomes more common. Among all SMILE cases, IFS was most commonly associated with steroid-induced ocular hypertension and a myopic shift around 21 days postoperatively. A fluid cleft at the interface may not always be visible with SLE, masquerading as DLK. Scheimpflug densitometry and anterior segment optical coherence tomography (AS-OCT) may aid in quantifying interface edema needed to confirm a diagnosis when IOP is unclear. A corneal washout can immediately improve corneal edema, but the preferred treatment is discontinuing all steroid medication and starting glaucoma drops.

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“…[1][2][3] The incidence of ingrowth following small-incision lenticule extraction (SMILE), although poorly reported, is believed to be lower than for LASIK due to the absence of the flap. 4 If left untreated, epithelial ingrowth can obstruct vision by inducing corneal astigmatism or obstructing vision by migrating toward the visual axis. Resulting epithelial defects or superficial punctate keratitis can result in irritation or a foreign body sensation.…”

mentioning

confidence: 99%

Epithelial cell curette: simple solution to epithelial cell removal from small-incision lenticule extraction pocket or LASIK flap

Agarwal

Thornell

2023

JCRS Online Case Rep

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Epithelial ingrowth is one of the complications associated with refractive laser surgery. Although treatment is relatively simple following laser in situ keratomileusis (LASIK), the inaccessibility of the pocket makes treatment following small-incision lenticule extraction (SMILE) somewhat difficult. An innovative scraping tool that features a biconcave curette tip allows for the manual removal of epithelial cells from the SMILE pocket without flushing or conversion to a flap. The tool can also be used to remove cells from beneath the LASIK flap without performing a complete relift.

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Complications of small incision lenticule extraction

Cited by 16 publications

References 110 publications

New mechanism for epithelial ingrowth after small incision lenticule extraction: Vertical epithelial gas breakthrough

New mechanism for epithelial ingrowth after small incision lenticule extraction: Vertical epithelial gas breakthrough

Interface Fluid Syndrome Masquerading as Diffuse Lamellar Keratitis After Small Incision Lenticule Extraction

Epithelial cell curette: simple solution to epithelial cell removal from small-incision lenticule extraction pocket or LASIK flap

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