Abstract
Purpose
To evaluate the safety and efficacy of stromal lenticule obtained from small-incision lenticule extraction (SMILE) surgery versus amniotic membrane graft (AMG) augmented with platelet-rich plasma (PRP) for the treatment of perforated corneal ulcers and compare the results between the two groups.
Patients and methods
This is a comparative retrospective study that included 40 eyes with medium-sized corneal perforations, which were classified into two equal groups of 20 eyes each; group (A) was treated with SMILE lenticule graft and group (B) was treated with AMG augmented with PRP. Pre- and postoperative evaluations were carried out using both slit-lamp (SL) examination and anterior segment optical coherence tomography (AS-OCT), including closure of perforation, complete healing, and best corrected visual acuity (BCVA).
Results
Complete closure of the perforation was achieved in both groups. However, healing was faster in the SMILE lenticule group than in the AMG with PRP group (P < 0.05). Complete healing was achieved in both groups: 100% in SMILE lenticule group and 95% in AMG with PRP group (P > 0.05). Both groups had few insignificant complications (30% in each), which were managed.
Conclusion
Both methods achieved adequate healing of corneal perforations within few weeks without significant complications. However, the stromal lenticule obtained from small-incision lenticule extraction (SMILE) surgery tended to be safer with faster healing than AMG with PRP.
Similar content being viewed by others
References
Deshmukh R, Stevenson LJ, Vajpayee R (2020) Management of corneal perforations: an update. Indian J Ophthalmol 68(1):7–14
Abd Elaziz MS, Zaky AG, El Saebay Sarhan AR (2017) Stromal lenticule transplantation for management of corneal perforations; one-year results. Graefes Arch Clin Exp Ophthalmol 255:1179–1184
Jhanji V, Young AL, Mehta JS, Sharma N, Agarwal T, Vajpayee RB (2011) Management of corneal perforation. Surv Ophthalmol 56:522–538
Abdelghany AA, El Bahrawy M, Alio JL (2021) Combined platelet rich plasma and amniotic membrane in the treatment of perforated corneal ulcers. Eur J Ophthalmol 32(4):2148–2152. https://doi.org/10.1177/11206721211049100
Yagci A (2012) Update on peripheral ulcerative keratitis. Clin Ophthalmol 6:747–754
Ganesh S, Brar S, Rao PA (2014) Cryopreservation of extracted corneal lenticules after small incision lenticule extraction for potential use in human subjects. Cornea 33:1355–1362
Jiang Y, Li Y, Liu XW, Xu J (2016) A novel tectonic keratoplasty with femtosecond laser intrastromal lenticule for corneal ulcer and perforation. Chin Med J 129:1817–1821
Pradhan KR, Reinstein DZ, Carp GI, Archer TJ, Gobbe M, Gurung R (2013) Femtosecond laser-assisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor. J Refract Surg 29:777–782
Fan J, Wang M, Zhong F (2016) Improvement of amniotic membrane method for the treatment of corneal perforation. Biomed Res Int 2016:1693815
Alió JL, Arnalich-Montiel F, Rodríguez A (2012) The role of “Eye platelet rich plasma” (E-PRP) for wound healing in ophthalmology. Curr Pharm Biotechnol 13:1257–1265
Al Saadany AI, El Gouhary SM, Abd Elaziz MS, Basiony AI, Omara AA (2019) Amniotic membrane versus corneal stromal lenticule grafting for the management of corneal perforations: a retrospective study. Delta J Ophthalmol 20:22–27
Kotb AN, Elsayed SH (2022) Double small incision lenticule extraction lenticular graft in impending corneal perforation. Delta J Ophthalmol 23:157–161
Hick S, Demers PE, Brunette I, La C, Mabon M, Duchesne B (2005) Amniotic membrane transplantation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases. Cornea 24:369–377
Rodriguez-Ares MT, Tourino R, Lopez-Valladares MJ, Gude F (2004) Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea 23:577–583
Wu F, Jin X, Xu Y, Yang Y (2015) Treatment of corneal perforation with lenticules from small incision lenticule extraction surgery: a preliminary study of 6 patients. Cornea 34:658–663
Funding
The authors have not disclosed any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Tawfeek, M.M.M., Ahmed, H.M.A.H., Bor’i, A. et al. SMILE lenticule versus amniotic membrane graft (AMG) augmented with platelet-rich plasma (PRP) for the treatment of perforated corneal ulcer. Int Ophthalmol 43, 2341–2348 (2023). https://doi.org/10.1007/s10792-023-02631-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-023-02631-3