Refractive small-incision lenticule extraction: Push-up and push-down techniques

Abstract

Neither author has a financial or proprietary interest in any material or method mentioned.

Small incision lenticule extraction (SMILE) techniques: patient selection and perspectives

“…Hamed and Fekry 34 used an instrument with a Y-shaped tip (Bechert Nucleus Rotator, product number E4937, Storz Ophthalmics, Bausch + Lomb, St. Louis, MO, USA) to identify the lenticule edge in case of lenticule mis-dissection. The instrument is inserted through the side-cut incision, and the edge of the lenticule is engaged between the two limbs of the Y-shaped tip.…”

“…Hamed and Fekry 34 describe the push-up technique to facilitate the identification of the lenticule edge. The authors used an instrument with a Y-shaped tip (Bechert Nucleus Rotator, product number E4937, Storz Ophthalmics) to engage the lenticule edge between the two limbs of the tip.…”

Intraoperative complications of refractive small incision lenticule extraction in the early learning curve

“…The ReSMILE push-up is a newly proposed technique ( Video S1 ) carried out using an instrument with a Y-shaped tip to “push-up” the edge of the lenticule from its bed prior to dissection, and hence, it becomes more easily recognizable. 9 The Y-shaped tip of the instrument is advantageous because it catches the edge of the lenticule easily between its 2 limbs ( Figure 1 ). The surgeon is now better guided to both planes of dissection superficial and deep to the lenticule by passing the dissecting spatula above or below the “pushed-up” edge of the lenticule that can be easily seen (after pushing-up) under the coaxial light of the microscope.…”

“…The caught edge of the lenticule is then pushed up from its bed, making it much easier to recognize inside the pocket ( Figure 1 ). 9 A spatula, the SMILE Double Ended Dissector with Spoon Tip (Duckworth and Kent, Hertfordshire, UK, Product Number: 6-836), is then passed below the pushed-up lenticule edge, dissecting a linear area resembling a tunnel below the middle of the deep surface of the lenticule, then passed above the pushed-up lenticule edge to dissect the lenticule from the cap and finally passed below the lenticule to dissect the remainder of the deep surface of the lenticule and fold it to one side. A non-toothed serrated micro-forceps, the smile lenticular removal forceps (Duckworth and Kent, Product Number: 2-836), is finally used to extract the lenticule.…”

“…The aim of this paper was to study the intraoperative complications of refractive small incision lenticule extraction (ReSMILE push-up technique) and to record the mean intraoperative duration time of all surgeries. 9 The ReSMILE push-up technique facilitates a crucial step of the surgery, which is dissection of the lenticule. We aimed at measuring the mean duration time of the ReSMILE push-up technique for the refractive surgeon in his early learning curve of SMILE.…”