Development of a liquid dissection technique for small-incision lenticule extraction: Clinical results and ultrastructural evaluation

To determine the effect of a liquid dissection technique on clinical outcomes with ultrastructural analysis of the lenticule surface in small-incision lenticule extraction (SMILE).Zhongshan Ophthalmic Center, Guangzhou, China.Prospective case series.Consecutive patients with myopia scheduled for small-incision lenticule extraction were included. The liquid dissection technique was performed in 1 eye and the traditional dissection technique was performed in the other eye by randomized assignment. Ophthalmic examinations were evaluated preoperatively and at different timepoint follow-ups after small-incision lenticule extraction. Ten human corneal lenticules were analyzed using scanning electron microscopy.The study comprised 29 patients (58 eyes). Uncorrected distance visual acuity (logarithm of the minimum angle of resolution) postoperative measurements at 2 and 4 hours were significantly better in the liquid dissection group than in the traditional dissection group (P < .001 and P = .001, respectively); however, there were no significant differences between the 2 groups at 1 day, 1 week, and 1 month postoperatively. Compared with the traditional dissection technique, the liquid dissection technique induced significantly fewer corneal aberrations at 2 hours and 1 month after the procedures (P = .031 and P = .016, respectively), the postoperative contrast sensitivity in the liquid dissection group was significantly higher after 1 day (P = .01). The liquid dissection samples showed smoother lenticule surfaces compared with the traditional dissection samples qualitatively and quantitatively (P = .004 and P < .001, respectively).The liquid dissection technique was helpful in facilitating better visual acuity recovery and produced smooth cuts in the early postoperative period.