Secondary Lenticule Remnant Removal After SMILE

PURPOSE: The authors report four cases of residual intrastromal lenticule after seemingly uneventful small incision lenticule extraction (SMILE) surgery and the outcome after a secondary procedure to remove the lenticule remnant. METHODS: Case reports. RESULTS: All four cases presented with suboptimal corrected distance visual acuity (CDVA) and refractive surprise. Irregularities in the corneal curvature and elevation were detected on corneal topography and tomography. Careful review of the intraoperative video showed an incomplete removal of the SMILE lenticule. All four cases underwent a secondary surgical procedure to remove the residual lenticule remnant. All cases had improvements in the CDVA, refraction, and topography, with the CDVA returning to the preoperative value (20/20) in all cases. CONCLUSIONS: Performing an early, secondary lenticular remnant removal operation is feasible, safe, and can result in improvement in both refraction and visual acuity. During the original SMILE surgery, surgeons should routinely examine the removed lenticule for completeness. [ J Refract Surg. 2017;33(11):779–782.]