Abstract
Purpose
To investigate the feasibility of intrastromal lenticule insertion to restore corneal shape in a model of ectatic human cornea.
Methods
For this experimental ex vivo study on 34 human corneas unsuitable for transplantation, 17 corneas were thinned by decentralized posterior excimer laser ablation to 200 μm thickness and 6.5 mm diameter and then inflated up to 100 mm Hg to expose the ectasias (recipient corneas). Pachimetry and topography were obtained. Stromal lenticules of the same diameter and thickness as the ectasias were shaped with a femtosecond laser from the remaining 17 donor corneas. An intrastromal pocket was created with femtosecond laser within the ectatic recipient corneas and the donor lenticule was inserted inside it. Changes in corneal architecture and profile were evaluated by means of corneal topography and anterior segment optical coherence tomography.
Results
All stromal lenticules were successfully implanted. Tomography confirmed regularity of the lenticule profile within the stromal pocket. Corneal thickness was significantly increased after the procedure (P < 0.0001). Maximal posterior elevation from the best-fitted toric ellipsoid was significantly reduced (P < 0.0001). Significant flattening of posterior K1 and K2 was also obtained (P = 0.041 and P = 0.004, respectively). Anterior and posterior astigmatism, anterior and posterior asphericity, and spherical aberration did not differ significantly after the procedure.
Conclusions
Femtosecond laser-assisted stromal lenticule addition is feasible for restoring corneal thickness to an ectatic area and for regularizing posterior corneal elevation. The technique opens new perspectives for the treatment of corneal ectasias.
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References
Mohammadpour M, Heidaria Z, Hashemic H (2018) Updates on managements for keratoconus. Curr Ophthalmol 30:110–124
Mastropasqua L, Nubile M (2017) Corneal thickening and central flattening induced by femtosecond laser hyperopic-shaped intrastromal lenticule implantation. Int Ophthalmol 37:893–904
Angunawela RI, Riau AK, Chaurasia SS, Tan DT, Mehta JS (2012) Refractive lenticule re- implantation after myopic ReLEx: a feasibility study of stromal restoration after refractive surgery in a rabbit model. Invest Ophthalmol Vis Sci 53:4975–4985
Liu H, Zhu W, Jiang AC, Precher AJ, Zhou X (2012) Femtosecond laser lenticule transplantation in rabbit cornea: experimental study. J Refract Surg 28:907–911
Riau AK, Angunawela RI, Chaurasia SS, Lee WS, Tan DT, Mehta JS (2013) Reversible femtosecond laser-assisted myopia correction: a non-human primate study of lenticule re-implantation after refractive lenticule extraction. PLoS ONE 8:e67058
Mastropasqua L, Nubile M, Salgari N, Mastropasqua R (2018) Femtosecond laser-assisted stromal lenticule addition keratoplasty for the treatment of advanced keratoconus: a preliminary study. J Refract Surg 34:36–44
Knox Cartwright NE, Tyrer JR, Jaycock PD, Marshall J (2012) Effects of variation in depth and side cut angulations in LASIK and thin-flap LASIK using a femtosecond laser: a biomechanical study. J Refract Surg 28:419–425
Alió Del Barrio JL, El Zarif M, Azaar A, Makdissy N, Khalil C, Harb W, El Achkar I, Jawad ZA, de Miguel MP, Alió JL (2018) Corneal stroma enhancement with decellularized stromal laminas with or without stem cell recellularization for advanced keratoconus. Am J Ophthalmol 186:47–58
Patel AK, Scorcia V, Kadyan A, Lapenna L, Ponzin D, Busin M (2012) Microkeratome-assisted superficial anterior lamellar keratoplasty for anterior stromal corneal opacities after penetrating keratoplasty. Cornea 31:101–105
Funding
This study was funded by a Grant from Bausch & Lomb Incorporated.
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Pedrotti, E., Cozzini, T., Fasolo, A. et al. Small-incision lenticule addition in ex vivo model of ectatic human corneas. Int Ophthalmol 39, 2575–2581 (2019). https://doi.org/10.1007/s10792-019-01106-8
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DOI: https://doi.org/10.1007/s10792-019-01106-8