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Customized Stromal Lenticule Implantation for Keratoconus Publisher Pubmed



Doroodgar F1, 3 ; Jabbarvand M3, 4 ; Niazi S2 ; Karimian F2 ; Niazi F2 ; Sanginabadi A5 ; Ghoreishi M6 ; Alinia C7 ; Hashemi H2, 4, 8 ; Alio JL9, 10
Authors
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Authors Affiliations
  1. 1. Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Department of Ophthalmology, Tehran University of Medical Science, Tehran, Iran
  4. 4. Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
  5. 5. Department of Optometry, Iran University of Medical Sciences, No. 3 Ketabi Street, Shariati Avenue, Tehran, 1544914599, Iran
  6. 6. Isfahan Ophthalmology Research Center, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran
  7. 7. Department of Public Health, Urmia University of Medical Sciences, Urmia, West Azerbaijan, Iran
  8. 8. Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
  9. 9. Division of Ophthalmology, Universidad Miguel Hernandez, Alicante, Spain
  10. 10. Vissum Miranza Alicante, Alicante, Spain

Source: Journal of Refractive Surgery Published:2020


Abstract

PURPOSE: To investigate the potential benefit of keratoconus surgery using customized corneal stromal donor lenticules obtained from myopic small incision lenticule extraction (SMILE) surgery by femtosecond laser. METHODS: In this prospective, consecutive, non-comparative series of cases, 22 lenticules were obtained from 22 myopic patients who had SMILE with a lenticule central thickness of greater than 110 µm. The lenticules were implanted in 22 eyes with advanced keratoconus. The lenticules were customized for the purpose of the implantation with either a simple necklace or necklace-with-ring shape (compound form) depending on the corneal thickness and corneal topography configuration of the implanted keratoconic eyes. The lenticules were implanted into a 9.5-mm corneal lamellar pocket created by the femtosecond laser. Changes in densitometry, thickness, confocal microscopy, corrected distance visual acuity (CDVA), and endothelial cell density were investigated. RESULTS: Intrastromal lenticule implantation was successfully performed in all cases without any complication. Corneal thickness showed a mean enhancement of 100.4 µm at the thinnest point. On biomicroscopy, all corneas were clear at 1 year postoperatively and there was a significant improvement in corneal densitometry during the entire follow-up period. Confocal biomicroscopy showed collagen reactivation without any inflammatory features caused by the implanted fresh lenticules. CDVA improved from 0.70 to 0.49 logMAR (P = .001) and keratometry decreased from 54.68 ± 2.77 to 51.95 ± 2.21 diopters (P = .006). CONCLUSIONS: Customized SMILE lenticule implantation by femtosecond laser proved to be feasible, resulting in an improvement in vision, topography, and refraction in the implanted eyes. Copyright © SLACK Incorporated
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