Managing suction loss during SMILE Yusuf YILDIRIM, MD Beyoglu Eye - PowerPoint PPT Presentation

Managing suction loss during SMILE Yusuf YILDIRIM, MD Beyoglu Eye Training and Research Hospital Cataract And Refractive Surgery Department Istanbul, TURKEY

SMILE-Suction Loss • Incidence 0.5-4.4% • Sudden eye or head movement • Decrease with surgical • Patient anxiety experience • Longer duration of suction • Bell Reflex Moshirfar M, McCaughey MV, Reinstein DZ et al. Small‐ incision lenticule extraction. J Cataract Refract Surg 2015; 41: 652 – 665. Wong CW, Chan C, Dan D et al. Incidence and management of suction loss in refractive lenticule extraction. J Cataract Refract Surg 2014; 40: 2002 – 2010 Clin Ophthalmol. 2018; 12: 665 – 668. Intraoperative complications of refractive small incision lenticule extraction in the early learning curve J Cataract Refract Surg. 2017 Jun;43(6):796-802.Incidence and management of intraoperative complications during small-incision lenticule extraction in 3004 cases Incidence, management and outcomes of suction loss during SMILE in 4,000 eyes. D.Reinstein et all. ESCRS 2017 Lisbon

Our Experience 2012-2018 Total patient 731 Suction Loss Total eyes 1426 Lenticule cut --- --- Suction Loss in first 100 Lenticule side cut 2 %0.14 cases – 8 eyes Flap cut 8 %0.56 Flap side cut 3 %0.21 Suction Loss after first 100 Total 13 % 0.91 cases – 5 eyes Learning curve is important

Suction Loss Re-centering to the exact same location is of biggest importance after a SMILE treatment interruption. If you have suction loss you must stop the procedure

SMILE: Incomplete Lenticule Cut – progress <10%

SMILE: Incomplete Lenticule Cut – progress >10% (conversion to flap)

SMILE: Incomplete Lenticule Side Cut

SMILE: Incomplete Cap Cut

Suction Loss-Incomplete Cap Cut

Has the suction loss impact on vision? Preoperative Postoperative UCVA: 0.2 UCVA: 0.9 BCVA: 0.9 (-3.75) BCVA: 0.9

SMILE: Incomplete Cap Side Cut

Suction Loss-Incomplete Cap Side Cut

Has the suction loss impact on vision? Preoperative Postoperative UCVA: 0.2 UCVA: 1,0 BCVA: 1.0 (-4.50 -0.50 170) BCVA: 1,0

Take home message • Giving information preoperatively is reduced patient’s anxiety • If you have suction loss you must stop the procedure • If it occurs; select appropiate approach (re-suction SMILE or convert to flap) During SMILE, unexpected problems may occur These problems can be successfully treated with proper approaches

Beyoglu Eye Training and Research Hospital First SMILE in Turkey (23/05/2012) Thank you …