As a relatively new procedure, femtosecond laser small incision lenticule extraction (SMIIE) is still in its initial stage.Despite the safety, efficacy, predictability and stability it has showed in refractive error correction, there are still reports of intraoperative complications resulting in different clinical outcomes in SMILE.SMILE includes the production of lenticule by femtosecond laser, the separation and extraction of lenticule, and intraoperative complications may occur in every step.The production of the lenticule is completely dependent on the femtosecond laser, so complications related to femtosecond lasers are inevitable, such as suction loss, opaque bubble layer and black spots.Separation and extraction of the lenticule relies on the experience and surgical skills of surgeon, during which, torn corneal cap, difficult lenticule extraction, lenticule remnants, bleeding and lenticule decentration may occur.In this article, the categories, reasons, management and effects of intraoperative complications on outcome in SMILE were summarized to improve the ability of ophthalmologists to handle intraoperative incidents and enhance surgical safety.

Refractive surgery is one of the important methods for refractive error correction, which include corneal refractive surgery and intraocular refractive surgery.In recent years, refractive surgery has a rapid development, and there is still development space and potential market demand.The clinical application of various new technologies has brought the refractive surgery to a new stage.The ultimate aim of refractive surgery is to pursue safer minimally invasive approaches and more customized correction for better visual quality.The new approaches including the guidance of corneal topography and wavefront aberration, the Q-value adjustment, Kappa angle adjustment, and customized corneal cross-linking during the surgery have been developed.The integration of various surgical approaches and research is also a new development direction.The combination with intelligent operation to improve the efficiency and accuracy of treatment seems to be one new direction, too.Ophthalmologists should pay attention to the current development and the possible future directions and trends of refractive surgery in China.

Objective:To investigate the changes of refraction power and higher-order aberrations under mesopic and photopic vision conditions.Methods:A cross-sectional study was performed.Seventy-one eyes of 71 patients with myopia or myopic astigmatism were enrolled in Tianjin Eye Hospital from February 6 to 28 in 2017.Spherical diopter, cylindrical diopter and higher-order aberrations were examined with NIDEK OPD Scan-Ⅲ.The pupil size, refractive power, total higher-order aberrations and Zernike aberration coefficients were compared between mesopic and photopic conditions.The study protocol was approved by an Ethics Committee of Tianjin Eye Hospital.Written informed consent was obtained from each subject prior to any medical examination.Results:The mean pupil diameter of the photopic conditions was significantly smaller than that of mesopic condition ( t=-66.730, P<0.001). The mean spherical equivalent (SE) were (-6.85±2.75)D and (-6.50±2.38)D under mesopic and photopic conditions, and mean cylindrical diopter were (-1.27±0.91)D and (-0.84±0.76)D, respectively, with statistically significant differences between the two conditions (both at P<0.001). There was no significant difference in spherical diopter between photopic and mesopic conditions ( P=0.212). The root mean square (RMS) values of total higher order aberration, total trefoil, total coma and total spherical aberration under mesopic condition were significantly higher than those under photopic condition (all at P<0.001), and the RMS values of Zernike aberration coefficients were significantly increased in mesopic condition compared with the photopic condition (all at P<0.001). Conclusions:Both refractive power and higher-order aberrations in photopic condition are higher than those in mesopic condition.