Penetrating keratoplasty after complicated small incision lenticule extraction a case report

PURPOSE: We present an interesting case of a 26-year-old woman who underwent penetrating keratoplasty due to complete corneal scarring on the right eye after complicated myopic SMILE. OBSERVATIONS: The spherical equivalent before laser treatment was −4.38D on the right eye and −4.00D on the left eye and topography showed a with-the-rule astigmatism on both eyes. The documented laser procedure was uneventful but wrong separation of the lenticule made a complete extraction of the lenticule not possible. The postoperative spherical equivalent showed −4,125D with an irregular astigmatism due to corneal scarring throughout the complete corneal stroma documented in OCT measurements. Due to serious anatomical changes of the cornea an uneventful penetrating keratoplasty was performed. CONCLUSION AND IMPORTANCE: SMILE procedure should be carefully performed as especially the lenticule separation and extraction can be a surgical challenge. In doubt, separation of the lenticule should not be enforced as it may lead to devastating outcome as presented in this case.