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Updated: Jan 28, 2026

Ye's Swing Technique for Small-incision Lenticule Extraction Surgery
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Flushing versus not flushing the interface during small-incision lenticule extraction.

Ralf Kind1, Laszlo Kiraly2, Suphi Taneri3

  • 1Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany.

Journal of Cataract and Refractive Surgery
|March 9, 2019
PubMed
Summary

Interface flushing with balanced salt solution after small-incision lenticule extraction (SMILE) shows no significant impact on visual recovery or complications. This procedure offers neither advantages nor disadvantages for patients undergoing SMILE surgery.

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Area of Science:

  • Ophthalmology
  • Refractive Surgery
  • Corneal Surgery

Background:

  • Small-incision lenticule extraction (SMILE) is a popular refractive surgical procedure.
  • Interface management after lenticule extraction is crucial for visual outcomes.
  • The role of balanced salt solution (BSS) flushing in SMILE requires further investigation.

Purpose of the Study:

  • To compare visual outcomes and complications between eyes with and without BSS interface flushing after SMILE.
  • To assess the impact of BSS flushing on uncorrected and corrected distance visual acuity (UDVA and CDVA).
  • To evaluate postoperative differences observed during slit-lamp examinations.

Main Methods:

  • A prospective case series involving 470 eyes across six German study centers.
  • One eye per patient underwent dry lenticule extraction with BSS flushing (1.0 cc via 27-gauge cannula).
  • Visual acuity (UDVA, CDVA) and slit-lamp findings were recorded and analyzed using paired t-tests.

Main Results:

  • No statistically significant differences in mean UDVA were observed at 1 day (0.81 vs. 0.83, P=.110) or 3 months (1.04 vs. 1.05, P=.172) between the non-flush and flush groups.
  • Similarly, no significant differences in the rate of postoperative complications were found.
  • The study found no discernible advantages or disadvantages associated with BSS interface flushing.

Conclusions:

  • Interface irrigation with 1.0 cc of BSS following refractive lenticule removal in SMILE does not offer significant benefits or drawbacks.
  • The procedure has no impact on visual recovery, postoperative complications, or final visual acuity.
  • Current evidence suggests BSS flushing is neither advantageous nor disadvantageous in SMILE surgery.