Refractive small-incision lenticule extraction: Push-up and push-down techniques

We describe 2 techniques for manipulating the edge of the lenticule in refractive small-incision lenticule extraction. In the push-up technique, an instrument with a Y-shaped tip is inserted through the incision and used to push the edge of the lenticule up, facilitating visualization of the edge of the lenticule, which might accelerate the learning curve of the beginning surgeon. The push-down technique is used if the surgeon notices that the lenticule is adherent to the cap after 1 surface has been dissected, making dissection of the superficial surface difficult. The same Y-shaped instrument can be used to engage the edge of the lenticule and push it down to make room to introduce the dissector; this is followed by dissection of the lenticule from the cap using the dissector.

Neither author has a financial or proprietary interest in any material or method mentioned.