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

I am a refractive surgeon specializing in laser and the ICL procedure. SMILE is a common refractive surgery, however, there is a learning curve in new surgeries. Lenticule tears is a serious complication of SMILE. Our technique aims to reduce the risk of lenticule tear. Our technique simplifies the key step of SMILE surgery, separate and remove the lenticule. It will help docs, especially for new surgeons, to reduce the risk of lenticule tears and to shorten the learning curve. We found that the key reason of the lenticule tears is the inward cutting force when the dissector counterclockwise swings from the nine to six o'clock at the posterior lenticule edge. So, our swing technique will reduce the inward cutting force and improve surgical safety. Our team focus on the safety and the precision of the refractive surgery, including cut the corneal screen, astigmatism collector, customized wavefront-guided excimer laser, and the long-term safety of ICL.

[Narrator] To begin, perform lenticule scanning using a femtosecond laser system. Set the laser system at 500 hertz with a pulse energy of 140 nanojoules. Then set the lenticule diameter to a range between 6.0 and 7.0 millimeters. Configure the intended cap thickness to 110 to 120 micrometers. Adjust the transition zone to 0.10 millimeters for cylindrical errors, and define a 2-millimeter incision at 110°. Now use a small surgical hook to open the full length corneal cap incision from left to right. Then dissect half the length of the lenticule incision from right to left. With a blunt spatula, separate the anterior surface of the lenticule, starting from the eight o'clock position. Proceed counterclockwise to the 12 o'clock position while leaving the rest of the lenticule undisturbed. Insert a blunt spatula underneath the posterior surface of the lenticule at the eight o'clock position. Then proceed with partial dissection in a counterclockwise direction up to the four o'clock position, preserving the peripheral edge. Guide the spatula along the edge toward the 12 o'clock position. Using femtosecond lenticule forceps, grasp the free edge of the lenticule and push it toward the center. Gently extract the lenticule with a continuous clockwise tearing motion. Examine the lenticule under a surgical microscope for structural integrity. Gently smooth the corneal cap and incision using an irrigation needle to complete the procedure. The average lenticule thickness extracted using Ye's swing technique was 106.30 micrometers with a range of 52 to 148 micrometers. Postoperative visual acuity improved to a logMAR of 0.04 ± 0.06 at one week postoperatively. The efficacy index reached 1.11 ± 0.13, and the safety index was 1.06 ± 0.12.