Development of the Modified Lenticule Edge Dissection Technique for Small Incision Lenticule Extraction

To identify and develop an efficient technique to separate the lenticule edge in small incision lenticule extraction (SMILE).

Four hundred eyes of 400 consecutive patients with myopia assigned to receive SMILE were included in the study. Eyes with poor-quality laser treatment were excluded, and the second eye of the same patient was included. Two skilled surgeons performed SMILE in the Zhongshan Ophthalmic Center. Each surgeon was allotted 200 patients. One surgeon used the modified technique, whereas the other surgeon used the conventional technique to identify and separate the lenticule edge. All intraoperative complications associated with lenticule edge dissection and the duration of lenticule dissection were recorded.

There were 200 eyes each in the modified technique group (group A) and the conventional technique group (group B). The mean lenticule dissection time was 49 ± 10 seconds in group A and 59 ± 43 seconds in group B (P = 0.002). Within 70 seconds, lenticule dissection was completely finished in 96.5% of eyes in group A and 86.0% in group B. Difficult lenticule dissection was experienced in 3.5% (7/200) of cases in group A and in 14.0% (28/200) of cases in group B.

The modified lenticule edge dissection technique of SMILE is simpler and faster in identifying the correct dissection plane. It is efficient in reducing surgical manipulation, shortening the learning curve required for lenticule dissection, and allows surgeons to perform SMILE more safely and efficiently.