Our guest surgeon is an expert in Small Incision Lenticule Extraction (SMILE) laser vision refractive surgery and has performed thousands at his clinic in South Korea. He shares some valuable pearls including ensuring a good, evenly moist corneal surface to deliver the laser energy effectively.

This eye has poor delivery of laser energy into the corneal stroma.
Even this eye has an area where the laser energy was not effectively delivered in one area and that will make the lenticule separation and extraction more challenging.

For femtosecond laser irradiation to be successful, a non-dry ocular surface and adequate femtosecond energy are important. If there is a foreign substance on the ocular surface or if it is too dry, there are areas (black spots in the pics) where the laser cannot be irradiated. In this case, it can be difficult for even an experienced surgeons to extract the lenticule. Therefore, it is important to proceed with the procedure (patient preparation, draping (+ speculum), docking & centration and Suction) before the laser process as quickly as possible, so that the laser process ends before the eyes dry out.

And if there is no evidence of a decrease in output hardware, you need to increase the energy setting value. However, if the energy is raised too much, OBL (opaque bubble layer) may occur, and in this case, it is important to note that the initial vision recovery after surgery may be slow.

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