Customized Stromal Lenticule Implantation for Keratoconus

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.