Incidence and management of intraoperative complications during small-incision lenticule extraction in 3004 cases.

PURPOSE: To assess the intraoperative complications during small-incision lenticule extraction (SMILE) for myopia and myopic astigmatism correction and evaluate visual outcomes 6 months postoperatively.

SETTING

Tianjin Eye Hospital, Tianjin, China.

DESIGN

Retrospective case series.

METHODS

Patients who had small-incision lenticule extraction surgery were examined 1 day, 7 days, 1 month, 3 months, and 6 months postoperatively. Demographic characteristics, visual outcomes, and intraoperative complications were recorded. Moreover, the incidence and management of the complications and the potential factors were analyzed.

RESULTS

Of the 3004 eyes (1511 patients), 134 (4.46%) had intraoperative complications, including suction loss (28 cases [0.93%]), incisional bleeding (28 cases [0.93%]), opaque bubble layer (22 cases [0.73%]), subconjunctival hemorrhage (20 cases [0.67%]), black areas (10 cases [0.33%]), unintended posterior plane dissection (10 cases [0.33%]), tearing of the lenticule (8 cases [0.27%]), abrasion at the incision (5 cases [0.17%]), and inaccurate laser pulse placement due to eye movement (3 cases [0.10%]). The complications were resolved instantaneously using appropriate management procedures; all cases had good visual outcomes. Six months postoperatively, 99.80% of cases had an uncorrected distance visual acuity better than 20/25 and the mean corrected distance visual acuity was -0.06 logarithm of the minimum angle of resolution ± 0.07 (SD).

CONCLUSIONS

Although small-incision lenticule extraction shows promising outcomes for correction of myopia and myopic astigmatism, intraoperative complications still inevitably occur. However, satisfactory visual outcomes may be achieved using appropriate management techniques.