Difficult lenticular extraction may sometimes occur in small incision lenticule extraction, especially if the posterior lenticular plane is inadvertently dissected before the anterior plane. Dr. Jacob has described the white ring sign as a means to facilitate easy identification of the anterior plane from the posterior plane of dissection and thereby prevent difficult and complicated SMILE lenticule extraction.
Differentiating the posterior plane from the anterior plane of dissection may sometimes be difficult, and inadvertent dissection of the posterior plane first results in a lenticule that
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