Impact of Suction Loss During Small Incision Lenticule Extraction (SMILE).

To evaluate the clinical results of suction loss in eyes during small incision lenticule extraction (SMILE). This prospective paired-eye case study enrolled 8,490 eyes of 4,296 patients, of which 35 eyes experienced suction loss during the SMILE procedure while being treated for myopia or myopic astigmatism. The eyes with suction loss were re-treated with SMILE, femtosecond laser-assisted LASIK (FS-LASIK), or pseudo SMILE, and the fellow eyes were treated with SMILE. Patients were examined before surgery and at 1 day, 1 week, and 1 and 3 months postoperatively. Corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), manifest refraction, higher order aberrations (HOAs), and morphologic modifications of corneal architecture were evaluated. At 3 months, patients were asked if they preferred the vision in either eye. High-contrast CDVA was worse in the eyes that suffered loss of suction than in the fellow eyes at 1 week postoperatively (two-tailed paired t tests, P = .04), but not at 1 and 3 months. There was no statistical significance between the two treatments in the safety and efficacy indices or the 3rd and 4th order aberrations at 3 months postoperatively (two-tailed paired t tests, all P > .05). No apparent abnormalities were observed in the corneas by frequency-domain optical coherence tomography. Re-treatment with femtosecond laser for incomplete SMILE was safe, predictable, and effective, and the patients did not perceive a difference in vision. [J Refract Surg. 2016;32(10):686-692.].