Official ESCRS | European Society of Cataract & Refractive Surgeons
Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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Suction stability management in SMILE: decision tree for managing eye movements and suction loss

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Session Details

Session Title: SMILE

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

Paper Time: 16:54

Venue: Room A3, Podium 2

First Author: : G.Carp UK

Co Author(s): :    D. Reinstein   T. Archer   R. Vida              

Abstract Details


To describe a suction stability management decision tree protocol for the management of eye movements and suction loss during SMILE.


London Vision Clinic, London, UK


If a suction loss occurs during SMILE, the VisuMax femtosecond laser software includes a treatment wizard module that provides the recommended action for treatment according to the step at which the suction loss occurred. However, there are situations where an alternative action may be preferable. A retrospective analysis of all SMILE treatments performed at the London Vision Clinic was performed to investigate cases of eye movements and suction loss. A decision tree was developed to extend the built-in treatment wizard for the complete range of possible scenarios related to eye movements or suction loss.


Seven types of eye movements were identified and a grading scale was derived to classify them. Type I eye movements: clinically negligible shift in position. The surgeon may want to pause the cutting, regain control, then continue (P/R/C). Type II eye movements: clinically significant shift in position. A surgeon-initiated suction loss (SISL) may be appropriate. Type III eye movements: suction loss. It may be safer to convert to LASIK rather than restarting SMILE. If a thicker cap has been used, it is possible to restart SMILE with a thinner cap after a suction loss during the lenticule interface.


The suction stability management decision tree that was developed enables the surgeon to react quickly and efficiently to eye movements and suction loss. Given the limited time available for making clinical decisions, it is useful to have a clear decision process prepared.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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