Femtosecond laser refractive lenticule extraction (ReLEx) is a novel procedure for treatment of myopia and myopic astigmatism, which eliminates the use of microkeratome and excimer laser. Currently there are two techniques: FLEx – femtosecond lenticule extraction (similar to conventional LASIK) and SMILE – small incision lenticule extraction, where no flap is created. This article describes surgical complications of both techniques in a retrospective review. In the FLEx group 18.3% of patients suffered intraoperative complications: suction loss, black spots (resulting in incomplete cleaving surface), bubbles in the interface, and lenticule misdissection. In the SMILE group 26.9% of patients experienced complications: epithelial defect, suction loss, opaque bubble layer, cap rupture, and lenticule rupture. Most of the reported problems were thought to be due to surgeons’ learning curve with no unfavourable long-term effects over mean follow-up of 36 months. Black spots and bubbles in the interface were classed as mild complications with no lasting effects on vision, however, the actual visual acuities or other long-term sequels were not reported. ReLEx procedures are gaining popularity as they have certain advantages over conventional LASIK. However, they carry a set of unique complications, resulting from femtosecond laser’s mode of action, and their initial learning curve has high intraoperative complications. 

Refractive lenticule extraction complications.
Ramirez-Miranda A, Ramirez-Luquin T, Navas A, Graue-Hernandez E.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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