CIRCLE Software for the Management of Retained Lenticule Tissue Following Complicated SMILE Surgery

To describe the therapeutic use of CIRCLE software (Carl Zeiss Meditec, Jena, Germany) for the management of retained lenticule tissue after complicated small incision lenticule extraction (SMILE).

Two patients were referred for consultation and treatment due to intraoperative complications during SMILE. In case 1, a black patch during laser delivery caused the lenticule to be torn irregularly from the undersurface during extraction and a sliver of it was retained in the pocket. Case 2 presented with false plane dissection and a completely retained lenticule on anterior segment optical coherence tomography. Both cases were managed using the CIRCLE software by converting the cap into a flap, thus making access to the interface possible.

In case 1, after lifting the flap a small sliver of tissue was found in the interface, which was dissected, following which a 20-µm phototherapeutic keratectomy was done to smooth the interface. In case 2, after lifting the flap the edge of the retained lenticule was identified by using an endoilluminator and the lenticule was separated and subsequently removed. Both cases showed significant improvement in uncorrected distance visual acuity, corrected distance visual acuity, and Objective Scatter Index score on day 1 after repair surgery.

CIRCLE software may be successfully used for managing retained lenticule tissue apart from performing enhancement after SMILE. [J Refract Surg. 2019;35(1):60-65.].