Management of incision failure during small incision lenticule extraction because of conjunctivochalasis

PURPOSE: We report a case of incision failure during small incision lenticule extraction (SMILE) and its management. OBSERVATIONS: The incision could not be made using the femtosecond laser because of a redundant conjunctiva, so it was instead done manually using a diamond knife. The lenticule was successfully separated and extracted. Three months after the procedure, the uncorrected distance visual acuity was 20/20 and no complication was observed. CONCLUSIONS AND IMPORTANCE: This case demonstrates that the conjunctiva should be carefully examined before SMILE. If a complication occurs because of conjunctivochalasis, it can be resolved with proper management without compromising the patient's visual acuity.