A case report demonstrates the innovative use of CIRCLE software to successfully manage suction loss in the SMILE procedure, suggesting new possibilities for improvement.
We report an innovative use of the CIRCLE software (Carl Zeiss, Meditec) to manage a case of suction loss during small-incision lenticule extraction (SMILE). We describe a case of unstable suction during the corneal side-cut incision, wherein an immediate re-hold was obtained on the cornea, and the femtosecond delivery was completed. However, the side-cut incision was formed in the paracentral anterior cornea. The CIRCLE software (Pattern D) was used to fashion a new corneal side cut and gain subsequent access to the lenticule. The patient achieved an uncorrected distance visual acuity of 20/20 on postoperative day one. We present a rare case where the machine was able to re-establish suction after an excessive eye movement, while the laser delivery proceeded to continue uninterrupted. CIRCLE software provided a unique and novel application for gaining access to the SMILE lenticule in the case of failure of corneal side-cut formation in the intended location.
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Sachdev et al. (2026) studied this question.
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