Treatment of superficial corneal opacities with corneal stromal lenticule obtained through SMILE surgery

To evaluate the clinical efficacy and feasibility of superficial corneal opacities treated by excimer laser phototherapeutic keratectomy (PTK) combined with small incision lenticule extraction (SMILE)-derived corneal stromal lenticule transplantation.

A retrospective interventional case series of nine patients aged 12-59y with superficial corneal opacity caused by different pathologies who underwent standardized PTK combined with SMILE-derived corneal stromal lenticule transplantation was examined. Lenticule patches were fixed with fibrin glue. All patients underwent pre- and post-operative clinical assessments at different times for up to 12mo. Slit lamp microscopy, corneal density, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and anterior segment optical coherence tomography (AS-OCT) were examined.

The patients' mean age was 36.00±5.80 (12-59)y. Seven eyes (77.8%) gained UDVA and CDVA at the last measurement compared to their preoperative levels. The densities of the total cornea, the total anterior corneal layer, and the anterior corneal layers of 0-2 and 2-6 mm decreased significantly by 12.4%, 27.5%, 46.7%, and 32.8%, respectively. After human allogeneic transplantation, the implanted lenticules of all eyes were clearly visible by AS-OCT and remained transparent without displacement or graft rejection. The thickness of the central cornea and corneal lenticule transplants were stable throughout the entire postoperative period. One case experienced the postoperative complication of delayed corneal epithelial healing.

PTK combined with SMILE-derived corneal lenticule transplantation improves long-term visual acuity. Therefore, it is a new, safe, and effective method for treating superficial corneal opacity.