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SMILE ou PRK...que ce qu'on doit faire?

How to manage a big black spot situation? Why did it appear: too long corneal exposure, excessive anesthetic drops, induced epithelial defect, dry eye? What to do and when it is better to retreat after an aborted procedure at this time?

A regular SMILE case with -7D SEQ and 504 corneal thickness, and BCVA 0,9. Due to patient’s anxiety the docking procedure took longer than usual and this induced a longer exposure of the cornea and the possibility of creating an epithelial defect, so a big black spot appeared during Laser lenticule creation. I stopped the procedure, moved to the other eye which I have done successfully. Next day an epithelial defect in the exact same area where the big black spot was. So, what to do? PRK or risk a second SMILE in a week?

As the optical zone was not touched and the epithelium healed, with a good Pentacam exam and a normal OCT of the cornea, I’ve decided to do a second SMILE, with the same settings, after seven days, paying very much attention to the centration; the procedure went very well. Next day after the surgery with a clear cornea and a SEQ of -1,25 D the was VA 0,5; in a week SEQ of -0,75 D and VA was 0,7.

After an intentional aborted procedure, a new SMILE treatment may be tempted, in certain situations and by an experienced SMILE surgeon as an "off label" approach.

Even in such a difficult situation, that occurred in the beginning of lenticule creation, one can still retreat with SMILE technique, obtaining good visual and refractive outcomes.