title: Incidence and management of suction loss in refractive lenticule extraction.
abstract: OBJECTIVE
  To describe the incidence, management, and outcomes of suction loss in refractive lenticule extraction (ReLEx).
  
  
  METHODS
  Tertiary eye hospital.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  All patients who experienced suction loss during refractive lenticule extraction from March 9, 2010, to August 5, 2013, were evaluated preoperatively, including slitlamp biomicroscopy, fundoscopy, corneal topography, ultrasound pachymetry, manifest and cycloplegic refractions, and measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities. Patients were followed at predetermined timepoints. At each follow-up visit, the UDVA and CDVA were measured and slitlamp biomicroscopy was performed. Manifest refraction was measured 1 and 3 months postoperatively.
  
  
  RESULTS
  During the study period, 340 refractive lenticule extractions were performed. The overall cumulative incidence of suction loss was 3.2%. The incidence of suction loss was 4.3% (2/46) for femtosecond lenticule extraction, 4.4% (8/183) for small-incision lenticule extraction, and 0.9% (1/109) for pseudo small-incision lenticule extraction. Of the 11 eyes in which suction loss occurred, 8 (72.7%) had a UDVA of 20/30 or better and 9 (81.8%) had a spherical equivalent within ± 0.5 diopter of emmetropia at 3 months. Suction loss occurred in 4 eyes during the posterior lenticule cut, in 5 eyes during the anterior lenticule cut, and in 2 eyes during the lamellar flap cut. In 9 of these (81.8%), suction was reapplied and the procedure was completed without further complications.
  
  
  CONCLUSIONS
  The incidence of suction loss during refractive lenticule extraction was relatively low. Good visual outcomes were achieved with appropriate management.
authors.affiliation: From the Singapore National Eye Centre and the Singapore Eye Research Institute, Singapore, Singapore.
authors.forename: Chee Wai
authors.initials: CW
authors.lastname: Wong
authors.affiliation: From the Singapore National Eye Centre and the Singapore Eye Research Institute, Singapore, Singapore.
authors.forename: Cordelia
authors.initials: C
authors.lastname: Chan
authors.affiliation: From the Singapore National Eye Centre and the Singapore Eye Research Institute, Singapore, Singapore.
authors.forename: Donald
authors.initials: D
authors.lastname: Tan
authors.affiliation: From the Singapore National Eye Centre and the Singapore Eye Research Institute, Singapore, Singapore. Electronic address: jodmehta@gmail.com.
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
mesh_terms: D000328:Adult; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D049008:Keratectomy, Subepithelial, Laser-Assisted; D020731:Keratomileusis, Laser In Situ; D008297:Male; D009216:Myopia / Q000601:surgery*; D009887:Ophthalmoscopy; D012029:Refraction, Ocular / Q000502:physiology; D054140:Refractive Surgical Procedures; D012189:Retrospective Studies; D013396:Suction / Q000009:adverse effects*; D013524:Surgical Flaps; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult