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Customized Stromal Lenticule Implantation for Keratoconus.

Farideh Doroodgar, Mahmoud Jabbarvand, Sana Niazi

    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
    |December 9, 2020
    PubMed
    Summary

    Customized corneal lenticules from small incision lenticule extraction (SMILE) surgery improved vision and corneal thickness in keratoconus patients. This femtosecond laser procedure demonstrated feasibility and positive outcomes for advanced keratoconus treatment.

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    Area of Science:

    • Ophthalmology
    • Corneal Surgery
    • Refractive Surgery

    Background:

    • Keratoconus is a progressive corneal ectasia leading to visual impairment.
    • Current treatments aim to halt progression and improve vision.
    • Novel surgical approaches are needed for advanced cases.

    Purpose of the Study:

    • To evaluate the efficacy of using customized corneal stromal lenticules from small incision lenticule extraction (SMILE) surgery for keratoconus treatment.
    • To assess visual, refractive, and topographical outcomes after intrastromal lenticule implantation in advanced keratoconus.

    Main Methods:

    • A prospective series of 22 eyes with advanced keratoconus received customized lenticules derived from myopic SMILE procedures.
    • Lenticules were shaped (necklace or necklace-with-ring) and implanted into a femtosecond laser-created corneal pocket.
    • Postoperative assessments included visual acuity, corneal thickness, topography, densitometry, and confocal microscopy.

    Main Results:

    • Successful implantation in all cases with no complications.
    • Significant increase in thinnest corneal thickness (mean 100.4 µm).
    • Improved corrected distance visual acuity (CDVA) and reduced keratometry.
    • Enhanced corneal densitometry and signs of collagen reactivation observed on confocal microscopy.

    Conclusions:

    • Customized SMILE lenticule implantation is a feasible surgical option for advanced keratoconus.
    • The procedure leads to significant improvements in visual acuity, corneal topography, and refractive error.
    • This technique offers a promising method for managing keratoconus using bio-engineered corneal tissue.