● AIM: To report the intraoperative complications associated
with small incision lenticule extraction (SMILE) and their
● METHODS: This was a retrospective consecutive
interventional clinical study, carried out on patients with
myopia and myopic astigmatism, who underwent SMILE
procedure. Type of intraoperative complications and their
management were recorded.
● RESULTS: Our study comprised 282 eyes of 141 patients
who were enrolled for SMILE surgeries. The intraoperative
complications included lost vacuum (18 eyes, 6.38%),
treatment decentration (6 eyes, 2.12%), wound bleeding (21
eyes, 7.45%), incomplete bubble separation (black islands)
(3 eyes, 1.06%), the epithelial defects (15 eyes, 5.32%). Incision
tear (27 eyes, 9.57%), lenticule adherence to the cap (6 eyes,
2.12%), and cap perforation occurred in 2 eyes (0.7%).
● CONCLUSION: Although SMILE is a promising technique
for the correction of myopia and myopic astigmatism with
predictable, efficient, safe refractive and visual outcomes,
complications can occur. However, most of them are related
to inexperience and are included in the learning curve
of the technique. More studies with a bigger number of
eyes are required to efficiently evaluate the intraoperative
complications and standardize their management strategies.