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Suction loss during small-incision lenticule extraction performed by a single surgeon: incidence, management, outcomes, and risk factors

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Session Details

Session Title: SMILE

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 16:48

Venue: Room A3, Podium 2

First Author: : B.Qin CHINA

Co Author(s): :    M. Li   Y. Shen   X. Zhou              

Abstract Details


To determine the incidence, management, outcomes and risk factors of suction loss during femtosecond laser small-incision lenticule extraction (SMILE) for the treatment of eyes with myopia and myopic astigmatism.


EENT Hospital of Fudan University, Shanghai, China.


12057 consecutive eyes treated with SMILE for myopia and myopic astigmatism between January 2013 and December 2016 were included. Eyes that developed suction loss were identified and surgical video was analyzed. Corneal topography, manifest refractions, and measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities were performed preoperatively, and at day 1 and 12 months postoperatively. Risk factors were determined for suction loss development.


Of the 12057 consecutive eyes that received SMILE, 27 eyes (0.22%) developed suction loss. 27/27 (100%) eyes had a UDVA of 20/25 or better at the long-term postoperative follow-up. Suction loss occurred in 14 eyes during cutting of lenticule, in 7 eyes during cutting of cap, and in 6 eyes during cutting of cap side. Suction was reapplied and the procedure was completed in 19 eyes. In 7 eyes, procedure was completed with separation of side cut. One eye received LASEK. Multivariate logistic regression models showed that eye laterality had a significantly higher risk for developing suction loss intraoperatively (P=0.02).


Incidence of suction loss during SMILE was low. Good visual outcomes were achieved with appropriate management. Eye laterality is a risk factor for the development of suction loss.

Financial Disclosure:


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