Circle software for management of suction loss during small-incision lenticule extraction

Abstract

A 20-year-old male presented to the Centre for Sight seeking correction for a myopic refractive error of −2.0 diopters (D) and −2.5 D in the right and left eye, respectively. Anterior segment and fundus evaluations were unremarkable. Corneal tomography was within normal limits with a thinnest pachymetry of 554 μm and 547 μm in the right eye and left eye, respectively. Small-incision lenticule extraction (SMILE) was planned. Conjunctival tissue encroachment under the contact interface, secondary to unstable suction, interfered with femtosecond laser penetration and a subsequently unformed cap side cut. Because the laser was delivered for the entire duration of the treatment, the software registered a complete laser delivery. This prevented a retreatment option, allowing completion of the incomplete side cut only. The cap was converted to a flap using Circle software (Pattern D), which allowed successful flap lift and access to the formed lenticule. A well-centered flap was noted at the first postoperative visit with an uncorrected distance visual acuity of 20/20.