Management and Outcomes of Retained Lenticules and Lenticule Fragments Removal After Failed Primary SMILE: A Case Series.

PURPOSE: To describe the management of and report the outcomes following the removal of retained lenticules or lenticule fragments after a complicated small incision lenticule extraction (SMILE).

METHODS

Three patients were referred for consultation due to intraoperative complications during SMILE. In case 1, the lenticule was torn during extraction and a central fragment was retained in the pocket. In case 2, the inferior part of the lenticule remained attached at the anterior plane and its detached, superior part was dislocated and folded at the inferior part of the pocket. In case 3, the lenticule was completely attached at the anterior plane. All cases underwent secondary surgery. The lenticule fragment was detached using the dissector's body and tip and was extracted using the advanced lenticule forceps. The retained lenticules were extracted after dissection of tissue bridges at the anterior plane and periphery.

RESULTS

Postoperatively, all eyes showed improvement of visual acuity and topographic regularization of the anterior corneal curvature. Complete removal of lenticule remnants was accomplished in cases 1 and 2. In case 3, the photodisruption during primary SMILE was incomplete at a peripheral area next to the incision. A small peripheral fragment, corresponding to the described peripheral area, remained attached after the lenticule removal and was left in situ but did not have any impact on visual acuity and quality.

CONCLUSIONS

Retained lenticules or lenticule fragments may induce irregular astigmatism and loss of visual acuity. Prompt removal restores visual acuity and induces the desired effect of the primary SMILE procedure. [J Refract Surg. 2017;33(12):848-853.].