New Instruments for Lenticule Extraction in Small Incision Lenticule Extraction (SMILE)

Abstract

Small incision lenticule extraction (SMILE) is an alternative to Laser-Assisted in situ Keratomileusis (LASIK) for correction of myopia. In cases where surgeons inadvertently dissect the posterior surface first, identification of the anterior surface and subsequent removal become difficult since the anterior surface of the lenticule is compacted against the anterior stromal surface. This may result in incomplete lenticule removal, and a remnant of intrastromal lenticule in SMILE may lead to visual sequelae. In order to aid surgeons in lenticule removal, we have designed and developed 5 novel SMILE lenticule strippers to locate and extract the lenticules more easily. The aim of this study was to investigate and compare the efficacy and quality of these lenticule strippers in assisting SMILE. Thirty porcine eyes were used. The ease of extraction and removal of the lenticule with different strippers was graded by an experienced SMILE surgeon, the extracted lenticule circularity was evaluated by calculating the lenticule circularity, and the intactness of the extracted lenticule edge was assessed using scanning electron microscopy. We found these novel strippers can be of great help to improve the safety and quality of SMILE surgery, particularly in those cases of difficult lenticule extraction.

A pilot study: lenticule quality of hyperopic small incision lenticule extraction (SMILE) in rabbits

“…This emphasizes the importance of good cooperation and careful surgical manipulation during the procedure, for both hyperopia and myopia correction. [17] Visible cavitation holes were absent in all lenticules except 1 in the myopia group that exhibited a few cavitation holes on the anterior surface. Cavitation holes are gas bubbles formed during the vaporization of the corneal tissue, and they affect scanning quality.…”

A pilot study: lenticule quality of hyperopic small incision lenticule extraction (SMILE) in rabbits

“…4 Images of posterior surface of myopia lenticule from the right eye of the rabbit numbered 2 at 100× magnification (a) and at 300 × magnification (b). With example of the score result of 8 points importance of good cooperation and careful surgical manipulation during the procedure, for both hyperopia and myopia correction [17].…”

Performing Reliable Lens Capsulotomy in the Presence of Corneal Edema With a Femtosecond Laser

“…ImageJ 1.38X software (http://imagej.nih.gov/ij/; provided in the public domain by the National Institutes of Health, Bethesda, MD, USA) was used to determine capsule/capsulotomy size by pixilation compared with a reference ruler and capsule circularity with the formula 4p 3 Area/(perimeter) 2 (value of 1.0 represented a perfect circle). 36 Capsules were washed twice in 13 PBS for 10 minutes each before being immersed in a fixative 2% solution of glutaraldehyde in PBS for 2 hours at room temperature, and then washed three times with distilled water before incubation in a 1% aqueous solution of osmium tetroxide (FMB, Singapore) for 1 hour at room temperature. Following this, the samples were dehydrated in increasing concentrations of ethanol (25%, 50%, 75%, 95%, and 100% ethanol, with 95% and 100% concentrations being performed twice).…”