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


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Bimanual lenticule extraction in SMILE

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Session Details

Session Title: SMILE

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

Paper Time: 17:30

Venue: Room A3, Podium 2

First Author: : M.Smorawski POLAND

Co Author(s): :    J. Wierzbowska                    

Abstract Details


To evaluate safety of novel lenticule extraction method in SMILE. To compare speed of visual recovery in standard and novel technique. Standard technique of lenticule separation (when tissue is separated by inserting spoon tip of double ended pocked dissector into virtual space between two tissue layers) is inevitabily connected with compression of keratocyte and collagen layers . In contrast to this, separation force in bimanual technique is divided in vertical and horizontal vectors making tissue compression less since only caused by horizontal vector


Department of Refractive Surgery, Optegra Eye Clinic, Warsaw,


140 eyes of 70 patients were included in this prospective, comparative study. 70 eyes had SMILE surgery with standard lenticule dissection using both tips of double ended pocket dissector (Standard Group).70 eyes had SMILE surgery with novel bimanual lenticule dissection (Novel Group). In the latest, “opposite forces technique” is employed to dissect planar cuts. When dissecting upper surface, dissecting spoon tip hold in dominant hand is slightly pulling up towards the cap during this process, while non-dominant hand holding the lenticule egde with forceps is exerting limited downward tension on lenticule surface to “unzip” planar cut with opposite forces.


After the surgery % of eyes recovering to 1.0 decimal VA on day 1 was 50.7% in Standard Group and 71.6% in Novel Group. This outcome tend to continue on 1,7,30,90 postoperative days. At each follow-up visit, cornea was transparent and follow up period was free of major complications. 3 eyes gain 1 line of BCDVA, no eyes lost any lines. All relevant data were statistically significant. Mean lenticule extraction time was 49 seconds for Standard Group and 28 seconds for Novel Group.


Clinical data may suggest that bimanual lenticule extraction renders faster visual rehabilitation. This advantage can be attributed to different, less traumatic way of stromal tissue separation. Novel bimanual lenticule extraction is safe alternative in SMILE surgery. Additionally, counter-traction induced by holding lenticule edge during blunt separation offers additional benefits of: atraumatic eye control, more effective tissue separation , more precise peripheral dissection, shorter surgery time.

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