Ye's Swing Technique for Small-incision Lenticule Extraction Surgery

Summary

We introduced an optimized surgical approach for small incision lenticule extraction, termed the Ye's Swing Technique. This technique enables the surgeon to perform lenticule separation and extraction more easily while minimizing the risk of incision-edge tears and lenticule fragmentation. The results of this study proved its safety and efficacy.

Abstract

We propose a novel approach for small incision lenticule extraction (SMILE) surgery, termed the Ye's Swing Technique. The separation and removal of the lenticule are among the most challenging steps of SMILE surgery. An improper technique can result in difficulties during lenticule extraction, lenticule rupture, and the presence of residual fragments. This technique was developed to address intraoperative challenges by preserving an unseparated peripheral edge on the posterior surface of the lenticule-a feature absent in conventional methods. In this study, 490 eyes with myopia or myopic astigmatism and lenticule thicknesses ranging from 52-148 µm were included, of which 38.6% were classified as thin lenticules. The results demonstrated that the stromal lenticule could be successfully dissected and completely removed in all participants without any incidence of incision margin tearing. The safety index was 1.06 ± 0.12, and the efficacy index was 1.11 ± 0.13 at 1 week postoperatively. These findings indicate that the modified technique is safe and effective, even with thinner lenticules.

Introduction

Over the past decade, small incision lenticule extraction (SMILE) has been frequently used for myopia correction. Although the lenticule scanning step in SMILE is fully automated using a femtosecond laser, the lenticule separation and extraction processes remain surgeon-dependent. These manual steps require substantial technical proficiency and may be associated with complications such as lenticule breakage or remnant fragments^1,2,3,4. Such complications can lead to stromal damage, heightened inflammatory responses, delayed visual recovery, ....

Protocol

This prospective study consecutively included patients who underwent SMILE surgery between May 1^st and July 30^th, 2022, at the Eye Hospital of Wenzhou Medical University, Hangzhou, China. All the surgical procedures were performed by the same ophthalmologist. This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Eye Hospital of Wenzhou Medical University (No. H2022-002-K-02-01), and written informed consent was obtained from all participants.

1. Patient selection

NOTE: A total o....

Results

Ye's Swing Technique was successfully applied to 246 patients (490 eyes). Table 1 summarizes the clinical characteristics and postoperative data of enrolled patients. The lenticule thickness was 106.30 ± 23.27 µm (ranging from 52-148 µm), with 38.6% classified as thin lenticules (<100 µm).

Using Ye's Swing Technique, lenticule dissection and extraction can be completed in approximately 30-60 s. All lenticules were extracted completely and successfully. No incision-edge tear.......

Discussion

Lenticule separation and extraction are the most challenging steps of SMILE. Inappropriate manipulation during this process may lead to complications such as incision-edge tears, corneal cap tears, epithelial defects, lenticule remnants, and delayed visual recovery⁴. In certain difficult cases, repeated attempts at lenticule dissection may be required, increasing corneal tissue manipulation and prolonging the surgical time¹⁹. This study describes the Ye's Swing Tec.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
0.1% fluorometholone	Allergan, Inc.	H20181090
0.5% levofloxacin	Santen, Inc.	H20150278
0.5% proparacaine hydrochloride	Alcon, Inc.	HJ20160133
Blunt spatula	Suzhou Mingren Medical Equipment Co., Ltd	INTRALASIK FLAP SPATULA, MR-G134T-4
Corneal topography system	Oculus, Wetzlar, Germany	OCULUS Pentacam HR 70900
Femtosecond lenticule forceps	Suzhou Xiehe Medical Devices Co., Ltd.	MR-G116T-4
Non-contact tonometer	Topcon, Japan	CANON TX-F
Small surgical hook	Suzhou Mingren Medical Equipment Co., Ltd	INTRALASIK FLAP SPATULA, MR-G134T-4
Spectral-domain optical coherence tomography	Optovue Inc., CA, USA	Optovue RTVue XR
Tobradex (tobramycin dexamethasone)	Alcon, Inc.	H20150119
VisuMax femtosecond laser system (500 Hz)	Carl Zeiss Meditec AG, Germany	ZEISS VisuMax