OSCE 1 Objective Structured Clinical Examination of FRCOphth exam إمتحان الزمالة البريطانية للعيون
A case of refractive corneal procedure: SMILE: SMall Incision Lenticule Extraction
Clinical findings:
SMILE incisions for Myopia
Posterior Vitreous Detachment and Myopic fundus.
Indications:
Myopia ranging from -0.5 D to -12 D spherical equivalent, with myopic astigmatism up to -5 D.
Age more than18 y
Mesopic pupil size less than 7mm
Central corneal thickness more than 475 mm
Residual stromal bed more than 250 mm
Stability of refraction more than 1 year
Keratometry : Expected keratometry after procedure more than 35D and less than 47D
Contraindications:
Absolute:
1-Corneal thinning disorders like keratoconus or pellucid marginal degeneration
2-Corneal scarring or opacity which would prevent laser penetration
3-Uncontrolled glaucoma/uveitis
4-Severe dry eye/blepharitis/severe ocular allergy
5-Active eye inflammation or infection
6- Pregnancy or lactation
Relative:
1-Age less than 18
2-Diabetes mellitus
3-Autoimmume disorders
4-Immunodeficient status
5-History of herpex simplex keratitis
6-Mild dry eye/mild ocular allergy
7- Irregular cornea or irregular corneal astigmatism
8- One eyed/single eye functionality
9- Epithelial basement membrane dystrophy
Complications :
Intraoperative:
1-Suction loss during the procedure.
2-Decentration of the treatment.
3-Incision tear or cap perforation during the procedure.
4-Tearing of the lenticule during the extraction process and subsequent retention of some lenticule tissue within the cornea.
5-Opaque bubble layer leading to difficult extraction of the lenticule.
6-Uncut areas of the lenticule owing to some foreign body or fluid between the contact glass and the cornea.
7-Lenticule adherence to the cap, resulting in a difficult extraction procedure.
8-Bleeding at the incision site.
9-Epithelial defects.
Postoperative :
1-Corneal haze.
2-Diffuse lamellar keratitis.
3-Epithelial defects.
4-Ectasia.
5-Dry eyes.
6-Undercorrection or over-correction.
7-Infection.