Impact of unintended initial dissection of the posterior plane during SMILE surgery on surgery time and visual outcomes

Abstract Background To study the impact of unintended initial dissection of the posterior plane (UIDPP) on operation time and surgical outcomes during small incision lenticule extraction (SMILE) surgery. Methods This was a retrospective study. Based on the SMILE procedure video, the operating eyes were assigned to the normal and UIDPP groups according to the presence or absence of UIDPP signals during surgery. The UIDPP group was further separated into early and late detection based on whether the complete dissection of the lenticule posterior plane or not. Patient's demographic data, preoperative evaluation data, operation time and postoperative outcomes were collected. Results Sixty-six patients (66 eyes) who underwent SMILE were included, with 24 eyes with UIDPP (13 in the early detection group and 11 in the late group). The optical zone was smaller (median 6.5 vs. 6.6, P = 0.007), and the operation time was longer (median, 189.5 vs. 91.0 s, P