CIRCLE software for creation of corneal side cut in small-incision lenticule extraction

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.