A 28-year-old woman had a history of wearing glasses for 10 years. She occasionally wore contact lenses for 5 years and had stopped wearing them for 2 months. Preoperative examination revealed BCDVA in the OD was -4.00/-0.50×65=20/25 and in the OS was -4.25/-0.50×135=20/25. The intraocular pressure was measured with a corneal biomechanical analyzer (Corvis ST, Oculus Germany) and was 23 mmHg (1 mmHg = 0.133 kpa) in the right eye and 20.5 mmHg in the left eye. For central cornea thickness (CCT), the right eye was 562 µm, and the left eye was 569 eft Corneal topography (Orbscan II; Bausch & Lomb, Rochester, New York,USA) showed a symmetrical left eye, and the front surface was classified as Type C, with a K1 of 42.10D and a K2 of 42.80D and a -0.70D corneal astigmatism at 52.6° (Figure 1). No obvious abnormalities were observed in the anterior segment from fundus examinations.
A VisuMax femtosecond laser system (Carl Zeiss Meditec AG, Jena, Germany) was used for bilateral SMILE for the correction of myopia and myopic astigmatism at The Army Military University Daping Hospital on January 1st, 2018. The patient had good fixation, excellent negative pressure absorption, and accurate center positioning during the operation. The laser pulse energy was 31, and the track distance was 4.5 .d. The thickness of the binocular corneal cap was 130 µbinocu diameter was 7.1 mm, the side cut angle was 95°, the incision position was 95°, and the incision width was 2.50 mm. During the operation, the process of microlens separation and removal went smoothly; upon the completion of the surgery, visual inspection revealed a complete microlens from each eye. After the operation, conventional local antibiotic and anti-inflammatory treatments were administered.
After one week of follow-up, the patient complained of poor vision in the left eye. Physical examination revealed a UCDVA of 20/20 in the OD and 20/40 in the OS and an IOP of 18.5 mmHg in the OD and 17.0 mmHg in the OS. Left eye subjective optometry showed BCDVA at +2.00×175=20/50, a K1 of 36.40D, a K2 of 37.90D, and a -1.50D corneal astigmatism at 162° (Figure 3). A slit lamp examination showed a faint trace of pale lines under the cornea of the left eye (Figure 4). Anterior segment optical coherence tomography showed a high corneal stroma; reflective, irregular signals( Figure 5); and so on. At this time, a diagnosis of postoperative remaining lenticules in the left eye was made. After the preoperative communication, lenticule fragment removal was performed on the left eye on February 27, 2018. The residual stromal lens was removed through the original incision (see video for attachment) and reviewed on February 28, 2018. UDVA of the OS was 20/20, The AS-OCT showed that the high reflectance and irregular signals disappeared from the corneal stroma (Figure 6). HE staining of the removed lens fragments suggested that the edges were not smooth, and the corneal stroma fibers ran irregularly (Figure 7).