Incidence and management of suction loss in refractive lenticule extraction

To describe the incidence, management, and outcomes of suction loss in refractive lenticule extraction (ReLEx).

Tertiary eye hospital.

Retrospective case series.

All patients who experienced suction loss during refractive lenticule extraction from March 9, 2010, to August 5, 2013, were evaluated preoperatively, including slitlamp biomicroscopy, fundoscopy, corneal topography, ultrasound pachymetry, manifest and cycloplegic refractions, and measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities. Patients were followed at predetermined timepoints. At each follow-up visit, the UDVA and CDVA were measured and slitlamp biomicroscopy was performed. Manifest refraction was measured 1 and 3 months postoperatively.

During the study period, 340 refractive lenticule extractions were performed. The overall cumulative incidence of suction loss was 3.2%. The incidence of suction loss was 4.3% (2/46) for femtosecond lenticule extraction, 4.4% (8/183) for small-incision lenticule extraction, and 0.9% (1/109) for pseudo small-incision lenticule extraction. Of the 11 eyes in which suction loss occurred, 8 (72.7%) had a UDVA of 20/30 or better and 9 (81.8%) had a spherical equivalent within ± 0.5 diopter of emmetropia at 3 months. Suction loss occurred in 4 eyes during the posterior lenticule cut, in 5 eyes during the anterior lenticule cut, and in 2 eyes during the lamellar flap cut. In 9 of these (81.8%), suction was reapplied and the procedure was completed without further complications.

The incidence of suction loss during refractive lenticule extraction was relatively low. Good visual outcomes were achieved with appropriate management.