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J Cataract Refract Surg. 2019 Jun;45(6):872-877. doi: 10.1016/j.jcrs.2019.02.036. Epub 2019 Apr 12.

Aborted small-incision lenticule extraction resulting from false plane creation and strategy for subsequent removal based on corneal layered pachymetry imaging.

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London Vision Clinic, London, United Kingdom; Biomedical Science Research Institute, Ulster University, Coleraine, United Kingdom; Columbia University Medical Center, New York, New York, USA; Sorbonne Université, Paris, France. Electronic address:
London Vision Clinic, London, United Kingdom.


We describe a complication of false plane creation during small-incision lenticule extraction (SMILE) and the surgical plan for subsequent lenticule removal. During a primary SMILE procedure to treat high myopia, the separator instrument entered a false lamellar plane as a result of an area of resistance caused by an area of opaque bubble layer (OBL). The procedure was aborted to avoid removing an irregular lenticule. Based on measurements of the anatomic landscape, a new inferonasal small incision was created. The lenticule was separated and removed without further incidence. The patient recovered as normal and at 6 months, the uncorrected distance visual acuity was 20/16-1. This case highlights the importance of monitoring the bubble layer creation and interface separation to avoid creating or removing an irregular lenticule. It also shows the importance of layered corneal imaging to analyze and diagnose complications as well as of aborting a procedure and planning lenticule removal at a later time if deemed appropriate.


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