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Hao Y, Zhu B, Wu T, Guo X. Sutureless lamellar keratoplasty with lenticule from small incision lenticule extraction for treating limbal dermoid: A case report. Exp Ther Med 2024; 27:57. [PMID: 38234620 PMCID: PMC10790163 DOI: 10.3892/etm.2023.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 08/15/2023] [Indexed: 01/19/2024] Open
Abstract
The present study reports the case of a superficial limbal dermoid surgically treated without suture by using a new technique of lamellar keratoplasty with allogenic lenticule from small incision lenticule extraction. The limbal lesion area was circumscribed by a trephine marker and lamellae were peeled off the anterior corneal stroma and sclera. After excision of the dermoid, the liquid on the bed was dried as much as possible and an appropriate stromal lenticule was attached to the implant bed without fibrin glue or suture. A bandage contact lens was applied to fix the graft. During postoperative follow-ups, the anterior segment optical coherence tomography, corneal refractive power, corneal topography and best-corrected visual acuity were examined to evaluate the surgical results. On the first day after the operation, the patient reported tearing and pain at the site. At one week after the operation, the patient reported no discomfort and conjunctival sutures were removed. At one month after the operation, the thickness of the lesion area was similar to that of the adjacent cornea, and the corneal curvature and refractive power of the lesion area were higher than that of the adjacent cornea. At three months after the operation, the patient was satisfied with the cosmetic outcome and no sign of corneal neovascularization, graft rejection or pseudo-pterygium formation was observed. The astigmatic error remained at 2.50 D. The present case provides insights into a potential treatment option for patients who need lamellar keratoplasty and may provide its benefit in contrast to conventional lamellar keratoplasty.
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Affiliation(s)
- Yanjun Hao
- Department of Pediatric Ophthalmology, Tianjin Aier Eye Hospital, Tianjin 300190, P.R. China
| | - Bin Zhu
- Department of Tear Duct Disorders, Shanxi Aier Eye Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Tao Wu
- Department of Tear Duct Disorders, Shanxi Aier Eye Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Xuming Guo
- Department of Ocular Surface and Refraction, Heji Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Han T, Shen Y, Shang J, Fu D, Zhao F, Zhao J, Li M, Zhou X. Femtosecond Laser-Assisted Small Incision Allogeneic Endokeratophakia Using a Hyperopic Lenticule in Rabbits. Transl Vis Sci Technol 2021; 10:29. [PMID: 34665231 PMCID: PMC8543388 DOI: 10.1167/tvst.10.12.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the morphologic and histopathologic changes in allogeneic endokeratophakia using hyperopic lenticules derived from small-incision lenticule extraction (SMILE). Methods Six New Zealand rabbits (12 eyes) were included in this experiment and randomly and evenly divided into donor and recipient groups. The donor group underwent bilateral hyperopic SMILE surgery, and the concave lenticules were implanted into eyes in the recipient group. Corneal topography and anterior segment optical coherence tomography (OCT) examinations were performed at 1 day, 1 week, 1 month, and 5 months after surgery. All eyes were enucleated 5 months after surgery. Hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM) were used to observe the corneal morphology in the recipient group. Results No complications were observed, and the corneas remained transparent in the follow-up period. There was mild corneal edema within 1 week after surgery. Slit-lamp microscopy and OCT showed that the lenticules were gradually integrated with the surrounding corneal stroma. HE staining showed that the arrangement of corneal collagen was regular. The boundary between the lenticules and surrounding tissue could be identified with HE staining and TEM, and no inflammatory cells were found under TEM. The corneal Km values were significantly lower at 5 months postoperatively compared to preoperatively (P < 0.05). Conclusions This pilot study showed that allogeneic hyperopic SMILE lenticule endokeratophakia seems to be safe and feasible. Translational Relevance Allogeneic hyperopic SMILE lenticule endokeratophakia may be applicable for the correction of corneal regression, ectasia, ultra-high myopia, or keratoconus.
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Affiliation(s)
- Tian Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Feng Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- The Department of Ophthalmology, Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Shang Y, Li Y, Wang Z, Sun X, Zhang F. Risk Evaluation of Human Corneal Stromal Lenticules From SMILE for Reuse. J Refract Surg 2021; 37:32-40. [PMID: 33432993 DOI: 10.3928/1081597x-20201030-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/30/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the pathogenicity and immunogenicity of human corneal stromal lenticules from small incision lenticule extraction (SMILE). METHODS Serological testing was completed prior to sample collection to rule out infectious diseases. Pathogens herpes simplex viruses (HSV) type 1 and type 2 were screened for by real-time fluorescent quantitative polymerase chain reaction, and bacteria, fungi, and Acanthamoeba from 128 lenticules of 64 patients were cultured. A total of 132 lenticules from 93 patients were randomly assigned to the fresh group, -78 °C anhydrous glycerol preservation group (glycerol group), and 0.1% sodium dodecyl sulfate decellularization group (SDS group) in pairs and detected by immunohistochemistry, Western blot, transmission electron microscopy, transmittance, and nanoindentation. RESULTS The fresh lenticules were all negative for HSV-1, HSV-2, bacteria, fungi, and Acanthamoeba. HLA-I A/B/C and HLA-II DR antigens were all expressed in fresh lenticules but were clearly reduced after preservation at -78 °C in anhydrous glycerol or decellularization in 0.1% SDS. The collagen fibers of the lenticules in the fresh group were regularly arranged, and the keratocytes were intact. The fibers in the glycerol group were regularly arranged, and the integrity of keratocytes was destroyed. The fibers in the SDS group were disordered and had no cellular structure. The transmittance and Young's modulus were highest in the fresh group, lower in the glycerol group, and lowest in the SDS group. CONCLUSIONS Risk of infection is low, but risk of rejection exists on the reuse of fresh human corneal stromal lenticules from SMILE. Anhydrous glycerol preservation at -78 °C is an ideal method for reducing antigens without damaging the structure and function of lenticules. [J Refract Surg. 2021;37(1):32-40.].
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Abstract
PURPOSE To search for novel geometric parameters for corneal limbal dermoids that enable the prediction of clinical and surgical outcomes. METHODS We reviewed the medical records and anterior segment photographs of 85 eyes of 85 patients with corneal limbal dermoids that had been surgically excised. Patients were assigned to the following 4 cohorts (multiple assignments allowed): postoperative visual acuity (cohort 1, n = 65), amblyopia (cohort 2, n = 67), postoperative scar formation (cohort 3, n = 51), and preoperative spontaneous progression of dermoids (cohort 4, n = 39). For geometric profiling, 11 geometric parameters of lesions, including orientation, angular width, and 9 ratio parameters, were preoperatively defined in each patient based on the digital anterior-segment photographs. Each geometric parameter and demographic variable were analyzed for correlation with postoperative outcomes (cohorts 1-3) and preoperative spontaneous dermoid progression (cohort 4). RESULTS The mean patient age at surgery was 6.0 ± 6.3 years. Among the geometric and demographic parameters analyzed, the invaded angular axis of dermoid to corneal diameter ratio had the highest r coefficient (r = 0.728) in cohort 1 and best stratified patients in cohort 2 (cutoff > 0.48) and cohort 3 (cutoff > 0.56). No parameters were correlated with spontaneous dermoid progression in cohort 4. CONCLUSIONS We devised geometric parameters to evaluate corneal limbal dermoids before surgery for the prediction of surgical outcomes. The invaded angular axis of dermoid to corneal diameter ratio value was the most significant factor associated with postoperative visual acuity, amblyopia development, and postoperative scarring.
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Sharma N, Agarwal R, Jhanji V, Bhaskar S, Kamalakkannan P, Nischal KK. Lamellar keratoplasty in children. Surv Ophthalmol 2020; 65:675-690. [DOI: 10.1016/j.survophthal.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023]
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Keratopigmentation: a comprehensive review. Eye (Lond) 2020; 34:1039-1046. [PMID: 31896801 DOI: 10.1038/s41433-019-0750-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/25/2019] [Accepted: 11/30/2019] [Indexed: 11/08/2022] Open
Abstract
Corneal keratopigmentation (KTP) has a long history of use in management of patients suffering from disfiguring corneal opacities. Due to progresses and modifications in KTP surgical techniques and its low rate of complications, it is taken into consideration to be used in selected groups of patients for therapeutic or functional indications. In this paper we present an overview on clinical applications of KTP in both cosmetic and functional aspects and also, we discuss the outcomes of KTP and its characteristics in experimental and histopathological studies.
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Surgical treatment of corneal dermoid by using intrastromal lenticule obtained from small-incision lenticule extraction. Int Ophthalmol 2019; 40:43-49. [PMID: 31735992 DOI: 10.1007/s10792-019-01201-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/08/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE To report a novel technique to treat superficial limbal dermoid by using the corneal intrastromal lenticules obtained from SMILE and to evaluate the initial clinical outcomes of lenticule patch graft for treatment of limbal dermoid. METHODS In this single-center case series, lenticules were obtained from patients undergoing SMILE for the correction of myopia and the lenticule patch graft was performed in three patients with limbal dermoid. Patients were postoperatively followed at first, second weeks and first, third months after surgery. The main measured outcome parameters were included the best-corrected visual acuity, transparency of graft, tectonic integrity and restoration of optical transparency. RESULTS All surgeries were successful, and all patients recovered well. Obviously, improving tendency in visual acuity and astigmatism was seen at the final follow-up in all eyes. No statistically significant difference has found in the thickness of the cornea between the surgical field and the corresponding normal field. Globe integrity was achieved in all cases, and no immune rejection or perforation was detected until the last follow-up visit in all eyes treated. CONCLUSIONS Lenticule keratoplasty may be a safe, feasible and inexpensive surgical option for the treatment of corneal dermoid. It retains globe integrity and decreases the risk of complications such as postoperative limbal ectasia and visible corneal scarring and should be widely promoted in the areas with shortage of donor corneas.
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Fibrin Glue-Assisted Closure of Macroperforation in Predescemetic Deep Anterior Lamellar Keratoplasty With a Donor Obtained From Small Incision Lenticule Extraction. Cornea 2019; 38:775-779. [PMID: 30882544 DOI: 10.1097/ico.0000000000001918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a case with multiple macroperforations and a double anterior chamber (AC) after predescemetic deep anterior lamellar keratoplasty. METHODS A patient was referred after undergoing complicated excision of pseudopterygium that extended onto the cornea. At presentation, an eccentric lamellar patch graft extending over the pupillary axis with a double AC was seen. Surgical intervention showed a predescemetic plane of dissection with 2 macroperforations and iris plugging of the peripheral perforations. Suturing and fibrin glue alone did not seal the macroperforation, and a donor lenticule from small incision lenticule extraction (SMILE) was used to close the larger perforation using fibrin glue. A trephine was then used to mark a larger area of predescemetic dissection that included the original patch graft. A donor corneal graft was sutured after stripping Descemet membrane (DM). RESULTS Postoperatively, the double AC resolved, and vision improved to 0.50 decimal equivalent (20/40) by 3 weeks. At 18-month postoperative follow-up, corrected distance visual acuity (CDVA) was 0.67 (20/30). The donor graft remained clear, and the SMILE lenticule with underlying sutures could be visualized. CONCLUSIONS A donor lenticule from SMILE surgery is a useful adjunct to seal macroperforations in deep anterior lamellar keratoplasty because the thin uniform lamellar tissue is easily applied using fibrin glue and gives uniform and good apposition on both host and donor sides. It can be used immediately without further preparation unlike hand-fashioned patch grafts.
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Calas E, Gueudry J, Muraine M. Modification majeure de la couleur des tatouages cornéens à propos de 3 cas. J Fr Ophtalmol 2019; 42:477-484. [DOI: 10.1016/j.jfo.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 11/25/2022]
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Severe color change in corneal tattoos: Report of 3 cases. J Fr Ophtalmol 2018; 41:e469-e475. [DOI: 10.1016/j.jfo.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/19/2018] [Accepted: 10/09/2018] [Indexed: 11/23/2022]
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Pant OP, Hao JL, Zhou DD, Wang F, Zhang BJ, Lu CW. Lamellar keratoplasty using femtosecond laser intrastromal lenticule for limbal dermoid: case report and literature review. J Int Med Res 2018; 46:4753-4759. [PMID: 30088427 PMCID: PMC6259413 DOI: 10.1177/0300060518790874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Small incision refractive lenticule extraction (SMILE) is a femtosecond laser technique to correct myopia and myopic astigmatism. Herein, we report a technique where intrastromal lenticule obtained from the SMILE procedure served as a graft for lamellar keratoplasty in the management of a limbal dermoid. An 18-year-old woman presented to the clinic with a corneal-limbal mass in the right eye. Slit-lamp examination revealed a vascularized circular mass of approximately 6 mm × 5 mm, which was attached at 7 o’clock in the inferotemporal region of the corneal limbus; this suggested limbal dermoid. Anterior segment optical coherence tomography revealed superficial involvement of the cornea. The patient was treated with excision and lamellar keratoplasty by using femtosecond intrastromal lenticule. The lenticule was sutured over the cornea with 10-0 interrupted nylon sutures. On postoperative follow-up, best-corrected visual acuity was 20/20; there was no corneal neovascularization and no sign of rejection. This case of limbal dermoid was managed by simple surgical excision and lamellar keratoplasty with a SMILE-extracted lenticule. This method may serve as an alternative surgical approach for management of limbal dermoid.
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Affiliation(s)
- Om Prakash Pant
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Ji-Long Hao
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Dan-Dan Zhou
- 2 Department of Radiology, the First Hospital of Jilin University, Changchun, China
| | - Fan Wang
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Bing-Jie Zhang
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Cheng-Wei Lu
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, China
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