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Li M, Wei R, Qin B, Chang JSM, Zhou X. Long-term results of allogenic corneal lenticule of hyperopic SMILE for post-LASIK ectasia. iScience 2024; 27:110689. [PMID: 39280629 PMCID: PMC11399612 DOI: 10.1016/j.isci.2024.110689] [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: 02/03/2024] [Revised: 05/19/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024] Open
Abstract
Post-laser-assisted in situ keratomileusis (LASIK) corneal ectasia is a severe complication of corneal refractive surgery, and cryopreserved lenticules from hyperopic small incision lenticule extraction (SMILE) may offer a promising treatment though their long-term safety and efficacy are still under investigation. In this prospective case series, six eyes from six patients with post-LASIK ectasia received lenticules (mean cryopreserved time: 63 days). The procedure involved lifting the corneal flap, implanting the lenticule, and repositioning the flap. Over a follow-up period of at least one year, uncorrected distance visual acuity (UDVA) improved from 1.52 ± 0.40 preoperatively to 0.74 ± 0.28 LogMAR. Two eyes gained one line of corrected distance visual acuity (CDVA), three gained two lines, and one gained over three lines. Spherical equivalents decreased from -14.67 ± 2.36 D to -8.75 ± 4.03 D (p = 0.02). Mean anterior K and total corneal refractive power decreased (p < 0.05). Thinnest corneal thickness increased from 359.2 ± 39.3 μm to 401.7 ± 53.4 μm (p = 0.02). These findings support the potential of cryopreserved lenticules for treating post-LASIK ectasia, though further refinement in refractive predictability is needed.
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Affiliation(s)
- Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Medical College and Zhongshan Hospital Immunotherapy Translational Research Center, Shanghai, China
| | - Bing Qin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - John S M Chang
- Department of Refractive Surgery, Hong Kong Sanatorium & Hospital; Department of Ophthalmology, Hong Kong University; Department of Ophthalmology, the Chinese University of Hong Kong, Hong Kong, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Li Z, Cheng Z, Jia Z, Tang Y. Treatment of Corneal Dermoid with Fibrin Glue Boned Multi-Layer Lenticules from Small Incision Lenticules Extraction Surgery: A Preliminary Study of Five Patients. Curr Eye Res 2024:1-7. [PMID: 39229665 DOI: 10.1080/02713683.2024.2398121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/20/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE Dermoid excision combined with lamellar keratoplasty was one of the most common surgical techniques for corneal dermoid. Due to the huge shortage of corneal donors, small incision lenticule extraction (SMILE) derived lenticules might be the novel and feasible corneal grafts instead of traditional corneal donors. Therefore, we tried to use FG boned multi-layer lenticules as grafts in the treatment of corneal dermoid. METHODS Five patients (the oldest patient was 54 years old and the youngest case was 5 years old) were diagnosed with corneal dermoid and complaining of blurred vision or unsatisfied cosmetic appearance. All patients underwent corneal dermoid excision combined with FG boned multi-layer corneal lenticules transplantation. Slit-lamp microscopy and anterior-segmental optical coherence tomography(AS-OCT)were used to observe ocular appearance, corneal grafts survival, epithelialization, transparency, interlamellar fluid accumulation and the degradation of FG. The preoperative and postoperative change of best-corrected visual acuity (BCVA) and astigmatism were respectively recorded. RESULTS All patients were satisfied with the postoperative cosmetic results. BCVA had been increased and astigmatism had been decreased in all cases. We observed that the FG boned multi-layer corneal lenticules were covered with smooth corneal epithelium in one week after transplantation and successfully adhered to the corneal beds, without any dislocation or interlayer separation. FG was gradually degraded and absorbed within 1 month after surgery. The lenticule grafts grew well without rejection and kept transparency during the follow-up period. CONCLUSIONS FG boned multi-layer lenticules would be the novel and feasible substitute for lamellar keratoplasty in the treatment of corneal dermoid. FG could not be only used as binder adhering multi-layer lenticules, closing the interlayer space of multi-layer lenticules, preventing the formation of interlayer fluid, but also increasing the thickness and toughness of lenticules, and therefore which is more facilitate to intraoperative suture.
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Affiliation(s)
- Zhen Li
- Department of Ophthalmology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, China
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, Sichuan Province, China
| | - Zhongxia Cheng
- Department of Ophthalmology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, China
| | - Ziyu Jia
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, Sichuan Province, China
| | - Yuyan Tang
- Department of Ophthalmology, The People's Hospital of Leshan, Leshan, Sichuan Province, China
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Bievel-Radulescu R, Ferrari S, Piaia M, Mandatori D, Pandolfi A, Nubile M, Mastropasqua L, Stanca HT, Ponzin D. Banking of post-SMILE stromal lenticules for additive keratoplasty: A new challenge for eye banks? Int Ophthalmol 2024; 44:355. [PMID: 39182212 PMCID: PMC11345333 DOI: 10.1007/s10792-024-03283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE ReLEx (Refractive Lenticule Extraction) Small Incision Lenticule Extraction (SMILE), the second generation of ReLEx Femtosecond Lenticule Extraction (FLEx), is a minimally invasive, flapless procedure designed to treat refractive errors such as myopia, hyperopia, presbyopia, and astigmatism. This review aims to provide a comprehensive overview of the methods for preserving SMILE-derived lenticules and discusses their potential future applications. METHODS A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases, focusing on articles published up to January 2024 and available in English. The authors also evaluated the reference lists of the collected papers to identify any additional relevant research. RESULTS No standardized protocols currently exist for the storage or clinical application of SMILE-derived lenticules. However, these lenticules present a promising resource for therapeutic uses, particularly in addressing the shortage of donor corneal tissues. Their potential applications include inlay and overlay additive keratoplasty, as well as other ocular surface applications. Further research is needed to establish reliable protocols for their preservation and clinical use. CONCLUSION SMILE-derived lenticules offer significant potential as an alternative to donor corneal tissues. Standardizing their storage and application methods could enhance their use in clinical settings.
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Affiliation(s)
- Raluca Bievel-Radulescu
- Fondazione Banca Degli Occhi del Veneto, Via Paccagnella, 11, 30174, Venice, Italy.
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, 030167, Bucharest, Romania.
| | - Stefano Ferrari
- Fondazione Banca Degli Occhi del Veneto, Via Paccagnella, 11, 30174, Venice, Italy
| | - Moreno Piaia
- Fondazione Banca Degli Occhi del Veneto, Via Paccagnella, 11, 30174, Venice, Italy
| | - Domitilla Mandatori
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. D'Annunzio of Chieti-Pescara, 66100, Chieti, Italy
| | - Assunta Pandolfi
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. D'Annunzio of Chieti-Pescara, 66100, Chieti, Italy
| | - Mario Nubile
- StemTeCh Group, Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology-CAST, University G. D'Annunzio of Chieti-Pescara, 66100, Chieti, Italy
| | - Leonardo Mastropasqua
- StemTeCh Group, Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology-CAST, University G. D'Annunzio of Chieti-Pescara, 66100, Chieti, Italy
| | - Horia Tudor Stanca
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, 030167, Bucharest, Romania
| | - Diego Ponzin
- Fondazione Banca Degli Occhi del Veneto, Via Paccagnella, 11, 30174, Venice, Italy
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Di Girolamo N. Biologicals and Biomaterials for Corneal Regeneration and Vision Restoration in Limbal Stem Cell Deficiency. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2401763. [PMID: 38777343 DOI: 10.1002/adma.202401763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/15/2024] [Indexed: 05/25/2024]
Abstract
The mammalian cornea is decorated with stem cells bestowed with the life-long task of renewing the epithelium, provided they remain healthy, functional, and in sufficient numbers. If not, a debilitating disease known as limbal stem cell deficiency (LSCD) can develop causing blindness. Decades after the first stem cell (SC) therapy is devised to treat this condition, patients continue to suffer unacceptable failures. During this time, improvements to therapeutics have included identifying better markers to isolate robust SC populations and nurturing them on crudely modified biological or biomaterial scaffolds including human amniotic membrane, fibrin, and contact lenses, prior to their delivery. Researchers are now gathering information about the biomolecular and biomechanical properties of the corneal SC niche to decipher what biological and/or synthetic materials can be incorporated into these carriers. Advances in biomedical engineering including electrospinning and 3D bioprinting with surface functionalization and micropatterning, and self-assembly models, have generated a wealth of biocompatible, biodegradable, integrating scaffolds to choose from, some of which are being tested for their SC delivery capacity in the hope of improving clinical outcomes for patients with LSCD.
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Affiliation(s)
- Nick Di Girolamo
- Mechanisms of Disease and Translational Research, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
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Procházková A, Poláchová M, Dítě J, Netuková M, Studený P. Chemical, Physical, and Biological Corneal Decellularization Methods: A Review of Literature. J Ophthalmol 2024; 2024:1191462. [PMID: 38567029 PMCID: PMC10985644 DOI: 10.1155/2024/1191462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
The cornea is one of the most commonly transplanted tissues worldwide. It is used to restore vision when severe visual impairment or blindness occurs in patients with corneal diseases or after trauma. Due to the global shortage of healthy donor corneas, decellularized corneal tissue has significant potential as an alternative to corneal transplantation. It preserves the native and biological ultrastructure of the cornea and, therefore, represents the most promising scaffold. This article discusses different methods of corneal decellularization based on the current literature. We searched PubMed.gov for articles from January 2009 to December 2023 using the following keywords: corneal decellularization, decellularization methods, and corneal transplantation. Although several methods of decellularization of corneal tissue have been reported, a universal standardised protocol of corneal decellularization has not yet been introduced. In general, a combination of decellularization methods has been used for efficient decellularization while preserving the optimal properties of the corneal tissue.
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Affiliation(s)
- Alexandra Procházková
- Department of Ophthalmology, Kralovske Vinohrady University Hospital and 3rd Medical Faculty, Srobarova 1150/50, Prague 10 100 34, Czech Republic
| | - Martina Poláchová
- Department of Ophthalmology, Kralovske Vinohrady University Hospital and 3rd Medical Faculty, Srobarova 1150/50, Prague 10 100 34, Czech Republic
| | - Jakub Dítě
- Department of Ophthalmology, Kralovske Vinohrady University Hospital and 3rd Medical Faculty, Srobarova 1150/50, Prague 10 100 34, Czech Republic
| | - Magdaléna Netuková
- Department of Ophthalmology, Kralovske Vinohrady University Hospital and 3rd Medical Faculty, Srobarova 1150/50, Prague 10 100 34, Czech Republic
| | - Pavel Studený
- Department of Ophthalmology, Kralovske Vinohrady University Hospital and 3rd Medical Faculty, Srobarova 1150/50, Prague 10 100 34, Czech Republic
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Min Klimesova Y, Nemcokova M, Netukova M, Baxant AD, Hlavackova M, Kacerovska J, Studeny P. Corneal stromal lenticule transplantation for the treatment of corneal ulcers. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:55-61. [PMID: 36695544 DOI: 10.5507/bp.2023.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers. METHODS This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months. RESULTS In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient. CONCLUSION The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation.
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Affiliation(s)
- Yun Min Klimesova
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic
| | - Martina Nemcokova
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic
| | - Magdalena Netukova
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic
| | - Alina-Dana Baxant
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic
| | | | | | - Pavel Studeny
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic
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Zhang Z, Sun B, Xia F, Yu Y, Shen Y, Yao P, Wang X, Zhou X, Zhao J. Study on the biological properties of SMILE-derived corneal stromal lenticules after long-term cryopreservation in nutrient capsules. Exp Eye Res 2024; 239:109756. [PMID: 38135134 DOI: 10.1016/j.exer.2023.109756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/25/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To investigate the long-term preservation effects of nutrient capsules on the physiological activity, collagen fiber structure and transmittance of corneal stromal lenticules derived from small incision lenticule extraction (SMILE). METHODS A new nutrient capsule was constructed for long-term preservation of SMILE-derived corneal stromal lenticules. The lenticules were randomly divided into 99% anhydrous glycerol, and hydrogel nutrient capsules. After preserving for 1 year at -80 °C, lenticules were compared with fresh lenticules. The optical transmittance, tissue morphology, ultrastructure, cells activity and immunogenicity of the lenticules was detected and compared between different groups. RESULTS The rate of apoptotic cells was significantly higher in the glycerol group compared with the nutrient capsule group (P < 0.0001). More viable cells were present in the lenticules after nutrient capsule preservation compared to the glycerol group (P = 0.0003). The mean transmittance of the lenticules in the glycerol group (50 ± 18%) was significantly lower (P = 0.0008) compared to the control group (75 ± 11%), and the lenticules transmittance of the nutrient capsule group (64 ± 15%) after long-term preservation was not significantly different (P = 0.23) compared to the control group. The structure of HE staining showed that the collagen fibers in the nutrient capsule group were arranged in parallel and neatly, and a few cavitation vesicles were visible inside the tissue. There was no significant difference in the number of lenticular collagen fibers in the nutritional capsule group compared to the fresh lenticule group (P = 0.06). HLA-DR, HLA-ABC, CD45, CD25 and CD69 expression was low in all groups of lenticules after preservation. CONCLUSIONS Nutrient capsules can preserve lenticules for a long time and maintain the transmission structure and cells activity of lenticules.
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Affiliation(s)
- Zhe Zhang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Bingqing Sun
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Fei Xia
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yanze Yu
- Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Yang Shen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Peijun Yao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Jing Zhao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University), Shanghai, China; Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Dong Y, Hou J, Zhang J, Lei Y, Yang X, Sun F. Epithelial thickness remodeling after small incision lenticule intrastromal keratoplasty in correcting hyperopia measured by RTVue OCT. BMC Ophthalmol 2024; 24:13. [PMID: 38191381 PMCID: PMC10773066 DOI: 10.1186/s12886-023-03272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE To characterize the in vivo corneal epithelial thickness (CET) remodeling profile in a population of eyes after small incision lenticule intrastromal keratoplasty (SMI-LIKE) for hyperopia. METHODS The CET profile was measured by RTVue-100 Fourier-domain OCT system across the central 6-mm diameter of the cornea of 17 eyes from 12 subjects (five males and seven females) who accepted corneal stromal lens implantation surgery for correcting hyperopia. The CET were measured at positions with a radius of 0-1.0 mm, 1.0-2.5 mm (divided into eight quadrants) and 2.5-3.0 mm (divided into eight quadrants) from the corneal center. Corneal maximum simulated keratometry (Km) was measured by Pentacam HR anterior segment analyzer to analyze CET changes. The examination data of subjects were collected in four time periods, which were preoperative, short-term postoperative (one week after surgery), mid-term postoperative (the last review within 3-6 months after surgery), and long-term postoperative (the last review over 1-2.5 years after surgery). The changes of CET were compared and analyzed in the four time periods. RESULTS Mean CET in 0-1.0 mm, 1.0-2.5 mm and 2.5-3.0 mm of the cornea decreased in one week after surgery, respectively, as compared to CET in the preoperative period, which turned from 55.06 ± 0.82 μm、54.42 ± 0.75 μm、53.46 ± 0.60 μm to 51.18 ± 1.05 μm (P = 0.005), 49.38 ± 0.70 μm (P = 0.000), 51.29 ± 0.59 μm (P = 0.025). In the mid-term postoperative period, mean CET in 0-1.0 mm and 1.0-2.5 mm areas kept thinner than mean CET in the preoperative period, CET in 0-1.0 mm is 50.59 ± 0.76 μm (P = 0.000),CET in 1.0-2.5 mm is 50.23 ± 0.57 μm (P = 0.000), while mean CET in 2.5-3.0 mm area recovered to the same thickness as the preoperative level, which is 54.36 ± 0.66 μm (P = 1.000), until the long-term period, CET stabilized in the above doughnut pattern. CONCLUSIONS After stromal lenticule implantation for hyperopia, CET showed a remodeled form of thinning in the 0-2.5 mm area and thickening in the 2.5-3.0 mm area, and remained stable within one year after surgery.
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Affiliation(s)
- Yahui Dong
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Jie Hou
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Jing Zhang
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Yulin Lei
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China.
| | - Xinghua Yang
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Fangfang Sun
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
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Polachova M, Netukova M, Benada O, Kucera T, Kolin V, Baxant AD, Sirolova Z, Studeny P. The new future perspective in corneal tissue utilisation - methods of preparation and preservation. BMC Ophthalmol 2023; 23:294. [PMID: 37386384 DOI: 10.1186/s12886-023-03048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE The goal of our study is to find an optimal approach to the preparation and preservation of corneal stromal tissue. We want to compare different methods of corneal stromal tissue creation and storage to optimize the efficacy of this process under the conditions of an eye bank. After we find the most suitable method to create a safe high quality product, we want to prove the possibility of using a single donor cornea for more than one patient. We would also like to verify the feasibility of making more corneal lenticules after the removal of a corneal endothelium for DMEK transplantation. METHODS We provided morphological (histology, scanning electron microscope) and microbiological analysis in order to compare different methods of corneal lenticule and corneal stromal lamellae preparation and preservation. We also tested the surgical handling of the tissue to secure a safe manipulation of the tissue for clinical use. We compared two methods of corneal lenticule preparation: microkeratome dissection and femtosecond laser. As methods of preservation, we tested hypothermia, cryopreservation at -80 degrees Celsius in DMSO (dimethyl sulfoxide) and storage at room temperature with glycerol. Some intrastromal lenticules and lamellae in each group were previously irradiated with gamma radiation of 25 kGy (KiloGray). RESULTS Corneal stromal lamellae prepared with a microkeratome have a smoother cut - side surface compared to lamellae prepared with a femtosecond laser. Femtosecond laser preparation caused more irregularities on the surface and we detected more conglomerates of the fibrils, while lamellae made with microkeratome had more sparse network. Using femtosecond laser, we were able to make more than five lenticules from a single donor cornea. Gamma irradiation led to damage of collagen fibrils in corneal stroma and a loss of their regular arrangement. Corneal tissue stored in glycerol showed collagen fibril aggregates and empty spaces between fibrils caused by dehydration. Cryopreserved tissue without previous gamma irradiation showed the most regular structure of the fibrils comparable to storage in hypothermia. CONCLUSION Our results suggest that formation of a corneal lenticule lamellae by microkeratome results in smoother corneal lenticules, while being much cheaper than formation by femtosecond laser. Gamma irradiation of 25 kGy caused damage of the collagen fibres as well as their network arrangement, which correlated with loss of transparency and stiffer structure. These changes impair possible surgical utilisation of gamma irradiated corneas. Storage in glycerol at room temperature and cryopreservation had similar outcomes and we believe that both methods are appropriate and safe for further clinical use .
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Affiliation(s)
- Martina Polachova
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic.
- Third Faculty of Medicine, Charles University in Prague, Ruska 87, 10000, Prague 10, Czech Republic.
| | - Magdalena Netukova
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
- International Eye Bank of Prague, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Oldrich Benada
- Institute of Microbiology of the Czech Academy of Sciences. Vídeňská 1083, 142 20 Prague 4 - Krč, Prague 10, 100 34, Czech Republic
| | - Tomas Kucera
- Institute of Histology and Embryology, First Faculty of Medicine, Charles University in Prague, Albertov 4, Prague 10, 128 00 Praha 2, Czech Republic
| | - Vojtech Kolin
- Department of Pathology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Alina-Dana Baxant
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Zuzana Sirolova
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
| | - Pavel Studeny
- Department of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Srobarova 1150/50, Prague 10, 100 34, Czech Republic
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Zhang H, Deng Y, Li Z, Tang J. Update of Research Progress on Small Incision Lenticule Extraction (SMILE) Lenticule Reuse. Clin Ophthalmol 2023; 17:1423-1431. [PMID: 37251989 PMCID: PMC10216859 DOI: 10.2147/opth.s409014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
The SMILE lenticule is a complete corneal stroma that is removed from SMILE surgery. Since the increasing number of SMILE surgeries, a large number of SMILE lenticules have been produced, so the reuse and preservation of the stromal lens has become a research hotspot. Due to the rapid development of the preservation and clinical reuse of SMILE lenticules, there have been many related studies in recent years, so we updated it on this basis. We searched PubMed, Web of Science, Embase, Elsevier Science, CNKI, WANFANG Data and other databases for all articles published on the preservation and clinical reuse of SMILE lenticules, screened useful articles, selected relevant articles published in the last five years as the main body for summary, and then reached a conclusion. The existing preservation methods of SMILE lenticule include Moist chamber storage at low temperature, cryopreservation technique dehydrating agent and corneal storage medium, which have their own advantages and disadvantages. Presently, smile lenticules can be used for the treatment of corneal ulcers and perforations, corneal tissue defects, hyperopia, presbyopia and keratectasia, which have been proven to be relatively effective and safe. More research on smile lenticule reuse needs to be carried out to confirm its long-term efficacy.
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Affiliation(s)
- Hao Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zeshi Li
- West China Clinical Medical College, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Hazra S, Akepogu J, Krishna S, Pulipaka S, Bagga B, Ramachandran C. Use of Decellularized SMILE (Small-Incision Lenticule Extraction) Lenticules for Engineering the Corneal Endothelial Layer: A Proof-of-Concept. Curr Eye Res 2023; 48:251-262. [PMID: 36458563 DOI: 10.1080/02713683.2022.2151018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
PURPOSE To demonstrate the suitability of using decellularized SMILE (Small-incision Lenticule Extraction) lenticules for culturing and transplanting the corneal endothelium (CE). METHODS The SMILE lenticules, obtained during refractive surgery, were decellularized by incubating in CE culture medium and fetal bovine serum. Decellularization was confirmed by hematoxylin and eosin staining, DAPI staining, and gel electrophoresis. The amount of DNA per milligram of dry tissue weight was calculated to quantify the residual nuclear content. The transparency of the decellularized lenticules was determined by calculating the modulation transfer function. Immunostaining for stromal collagens and glycosaminoglycan was performed using specific antibodies. Engineered tissue was constructed by culturing the CE cells on lenticules and staining for ZO-1, Na/K ATPase, and N-cadherin. The functionality of the engineered tissues was assessed by transplanting them onto edematous human donor corneas and perfusing for 10 days ex-vivo. RESULTS The residual DNA per milligram of dry tissue weight was found to be significantly reduced (p < 0.0001) in serum (0.255 µg/mg) and Opti-MEM (0.140 µg/mg) when compared to fresh lenticules (3.9 µg/mg). Decellularization did not alter the arrangement of the collagen fibers or the transparency of the lenticules. CE cells attached and matured to express ZO-1, Na/K ATPase, and N-cadherin at two weeks after seeding. The engineered tissue upon transplantation significantly reduced the corneal edema (p < 0.05) and the transplanted cells remained intact on the SMILE lenticule post-transplantation. CONCLUSION This study demonstrates the suitability of using SMILE lenticules decellularized using a simple, chemical-free method for engineering the corneal endothelium for transplantation.
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Affiliation(s)
- Swatilekha Hazra
- Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Manipal Academy of Higher Education, Manipal University, Manipal, India
| | - Jacquelyn Akepogu
- Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Manipal Academy of Higher Education, Manipal University, Manipal, India
| | - Supriya Krishna
- Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Ludwig-Maximilians University, Munich, Germany
| | - SriRavali Pulipaka
- Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad, Telangana, India
| | - Bhupesh Bagga
- Department of Cornea and Anterior Segment, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Charanya Ramachandran
- Professor Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Rao J, Zhou Q, Chen J, Gu J, Wang Y, Liu Y. Carbodiimide crosslinked decellularized lenticules as a drug carrier for sustained antibacterial eye treatments. Biomed Mater 2023; 18. [PMID: 36751124 DOI: 10.1088/1748-605x/acb67b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
In this study, the drug-loading and antibacterial activity of carbodiimide/N-hydroxysuccinimide (EDC/NHS) crosslinked decellularized lenticules (CDLs) were evaluated. Small incision lenticule extraction derived lenticules were decellularized and modified with crosslinking concentrations of 0.00 (E/L00, non-crosslinked), 0.01 (E/L01), 0.05 (E/L05) and 0.25 mmol (E/L25) EDC per mg lenticules at 5:1 EDC/NHS ratios with non-decellularized non-crosslinked lenticules (NDLs) as controls. NDLs and EDC/NHS CDLs had similar water contents. The light transmittance percentages (400-800 nm) were 91.55 ± 1.16%, 88.68 ± 1.19%, 80.86 ± 1.94%, 85.12 ± 2.42% and 85.62 ± 2.84% for NDLs, E/L00, E/L01, E/L05 and E/L25, respectively (P< 0.01). The EDC/NHS CDLs (diameter: 6.36 ± 0.18 mm; central thickness: 117.31 ± 3.46 μm) were soaked in 3% (wt./vol.) levofloxacin (LEV) solution for 3 h. The drug release concentrations of LEV-impregnated EDC/NHS CDLs were determined by high-performance liquid chromatography. Zone inhibition (ZOI) againstStaphylococcus aureusof E/L01, E/L05 and E/L25 were superior to E/L00 CDLs (P< 0.01) and among the different crosslinked groups, E/L05 lenticules produced the largest ZOIs and their drug concentration release over 21 d was the highest. EDC/NHS crosslinking can improve the drug-loading effect and antibacterial activity of decellularized lenticules. LEV-impregnated EDC/NHS CDLs are promising drug delivery carriers.
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Affiliation(s)
- Jing Rao
- Department of Ophthalmology, Chongqing Opyometry Eye Hospital, Chongqing 400020, People's Republic of China
| | - Qizhi Zhou
- Department of Ophthalmology, Chongqing Opyometry Eye Hospital, Chongqing 400020, People's Republic of China
| | - Jiansu Chen
- Department of Ophthalmology, Aier Eye Institute, Changsha 410000, People's Republic of China
| | - Jianing Gu
- Department of Ophthalmology, Aier Eye Institute, Changsha 410000, People's Republic of China
| | - Yini Wang
- Department of Ophthalmology, Aier Eye Institute, Changsha 410000, People's Republic of China
| | - Yonghuan Liu
- Department of Ophthalmology, Aier Eye Hospital (Changsha), Changsha 410015, People's Republic of China
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SMILE lenticule versus amniotic membrane graft (AMG) augmented with platelet-rich plasma (PRP) for the treatment of perforated corneal ulcer. Int Ophthalmol 2023:10.1007/s10792-023-02631-3. [PMID: 36692698 DOI: 10.1007/s10792-023-02631-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
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.
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Hu X, Wei R, Liu C, Wang Y, Yang D, Sun L, Xia F, Liu S, Li M, Zhou X. Recent advances in small incision lenticule extraction (SMILE)-derived refractive lenticule preservation and clinical reuse. ENGINEERED REGENERATION 2023. [DOI: 10.1016/j.engreg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Mastropasqua L, Nubile M, Acerra G, Detta N, Pelusi L, Lanzini M, Mattioli S, Santalucia M, Pietrangelo L, Allegretti M, Dua HS, Mehta JS, Pandolfi A, Mandatori D. Bioengineered Human Stromal Lenticule for Recombinant Human Nerve Growth Factor Release: A Potential Biocompatible Ocular Drug Delivery System. Front Bioeng Biotechnol 2022; 10:887414. [PMID: 35813999 PMCID: PMC9260024 DOI: 10.3389/fbioe.2022.887414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/08/2022] [Indexed: 12/12/2022] Open
Abstract
Small incision lenticule extraction (SMILE), is a surgical procedure for the myopia correction, during which a corneal stromal lenticule is extracted. Given that we have previously demonstrated how this discarded tissue could be repurposed as a bio-scaffold for stromal engineering, this study aimed to explore its use as an ocular drug delivery system of active molecules, using neurotrophic factor Nerve Growth Factor (NGF). We employed human stromal lenticules directly collected from healthy donors undergoing SMILE. Following a sodium dodecylsulfate (SDS) treatment, decellularized lenticules were incubated with a suspension of polylactic-co-glycolic-acid (PLGA) microparticles (MPs) loaded with recombinant human NGF (rhNGF-MPs). Fluorescent MPs (Fluo-MPs) were used as control. Data demonstrated the feasibility to engineer decellularized lenticules with PLGA-MPs which remain incorporated both on the lenticules surface and in its stromal. Following their production, the in vitro release kinetic showed a sustained release for up to 1 month of rhNGF from MPs loaded to the lenticule. Interestingly, rhNGF was rapidly released in the first 24 h, but it was sustained up to the end of the experiment (1 month), with preservation of rhNGF activity (around 80%). Our results indicated that decellularized human stromal lenticules could represent a biocompatible, non-immunogenic natural scaffold potential useful for ocular drug delivery. Therefore, combining the advantages of tissue engineering and pharmaceutical approaches, this in vitro proof-of-concept study suggests the feasibility to use this scaffold to allow target release of rhNGF in vivo or other pharmaceutically active molecules that have potential to treat ocular diseases.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Mario Nubile
- Ophthalmology Clinic, Department of Medicine and Aging Science, “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | | | - Nicola Detta
- Dompé Farmaceutici SpA, Via Tommaso de Amicis, Naples, Italy
| | - Letizia Pelusi
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Manuela Lanzini
- Ophthalmology Clinic, Department of Medicine and Aging Science, “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Simone Mattioli
- Dompé Farmaceutici SpA, Via Tommaso de Amicis, Naples, Italy
| | - Manuela Santalucia
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Laura Pietrangelo
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Harminder S. Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Group, Singapore Eye Research Institute, Corneal and External Department, Singapore National Eye Centre, Singapore, Singapore
| | - Assunta Pandolfi
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Domitilla Mandatori
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), StemTeCh Group, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- *Correspondence: Domitilla Mandatori,
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Effects of Corneal Stromal Lens Collagen Cross-Linking Regraft on Corneal Biomechanics. J Ophthalmol 2022; 2022:8372156. [PMID: 35721228 PMCID: PMC9200565 DOI: 10.1155/2022/8372156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/08/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Corneal collagen cross-linking (CXL) therapy, a method that uses a combination of riboflavin and ultraviolet-A light (UVA), can promote the formation of covalent cross-linking of amino acid residues of corneal collagen and enhance the hardness of the cornea. In this study, we explored the effects of corneal stromal lens collagen cross-linking regraft on corneal biomechanics. Methods A total of 15 New Zealand white rabbits were divided into 3 groups: normal control group (group A), SMILE + uncross-linked lens implantation group (Group B), and SMILE + cross-linking lens implantation group (group C). The design parameters of SMILE surgery were as follows: the corneal cap was 120 um thick, the lens diameter was 6.5 mm, and the diopter was -6.0D. Riboflavin and ultraviolet-A (UVA) were used as corneal stromal lens CXL, which was implanted into the allogeneic rabbit corneal stromal bag 24 hours after the operation. Postoperative corneal thickness (CCT), refraction, AS-OCT, and corneal biomechanics were performed before and then at 1 and 3 months after the operation. Results All corneas appeared transparent and smooth 3 months after surgery. The corneal thicknesses of both group B and group C were lower than those before the operation. The corrected refraction of group B and group C after lens implantation was also lower than the expected corrected power; there was no significant difference between the two groups (P > 0.05). AS-OCT results showed an uneven surface and thickness of the corneal stromal lens in two eyes of group B. Moreover, corneal elastic deformation increased with intraocular pressure in each group; displacement from large to small was group B > group C and > group A. The creep from large to small was group B > group C > group A. The fiberboard layers of groups B and C were disordered, and there were a few autophagosomes in the fibroblasts of group B by transmission electron microscopy (TEM). Conclusions Allograft graft of corneal stromal lens collagen cross-linked can significantly increase the biomechanical properties of the cornea.
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Preservation of corneal stromal lenticule: review. Cell Tissue Bank 2022; 23:627-639. [DOI: 10.1007/s10561-021-09990-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022]
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Yin H, Chen X, Hong X, Ma J, Wu F, Wan T, Sang Y, Fu Q, Qin Z, Lyu D, Wu W, Yin J, Yang Y. Effect of SMILE-derived decellularized lenticules as an adhesion barrier in a rabbit model of glaucoma filtration surgery. BMC Ophthalmol 2021; 21:329. [PMID: 34503472 PMCID: PMC8431885 DOI: 10.1186/s12886-021-02090-3] [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: 05/03/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background To investigate the effects of small incision lenticule extraction (SMILE)-derived decellularized lenticules on intraocular pressure (IOP) and conjunctival scarring in a rabbit model of glaucoma filtration surgery. Methods Trabeculectomy was performed on both eyes of New Zealand rabbits. A decellularized lenticule was placed in the subconjunctival space in one eye of the rabbits (the decellularized lenticule group), and no adjunctive treatment was performed in the fellow eye (the control group). The filtering bleb features and IOP were evaluated 0, 3, 7, 14, 21, and 28 days after surgery, and histopathologic examination was performed 28 days after surgery. Results Decellularized lenticules significantly increased bleb survival and decreased IOP postoperatively in the rabbit model with no adverse side effects. The histopathologic results showed a larger subconjunctival space and less subconjunctival fibrosis in the decellularized lenticule group. Conclusions Decellularized lenticules can prevent postoperative conjunctiva-sclera adhesion and fibrosis, and they may represent a novel antifibrotic agent for trabeculectomy.
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Affiliation(s)
- Houfa Yin
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Chen
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaogang Hong
- Department of Ophthalmology, People's Hospital of Kaihua, Kaihua, China
| | - Jian Ma
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Wu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Wan
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiwen Sang
- Department of Laboratory Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiuli Fu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenwei Qin
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danni Lyu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinfu Yin
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yabo Yang
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 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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He N, Song W, Gao Y. Treatment of Mooren's ulcer coexisting with a pterygium using an intrastromal lenticule obtained from small-incision lenticule extraction: case report and literature review. J Int Med Res 2021; 49:3000605211020246. [PMID: 34130538 PMCID: PMC8212381 DOI: 10.1177/03000605211020246] [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] [Indexed: 11/25/2022] Open
Abstract
The coexistence of Mooren’s ulcer and a pterygium is an extremely rare ocular condition
that has been infrequently reported in the literature to date. We herein present the first
case of treatment of Mooren’s ulcer coexisting with a pterygium using a lenticule obtained
by myopic small-incision lenticule extraction (SMILE). A 61-year-old woman presented with
a 3-month history of recurrent ocular pain and red eye caused by Mooren’s ulcer coexisting
with a pterygium. She received topical immunosuppressive and anti-infection treatments for
almost 3 months. However, her ocular symptoms and signs did not substantially improve.
Therefore, we performed lamellar keratoplasty with a corneal lenticule obtained by SMILE,
followed by pterygium excision combined with conjunctival autografting. The patient
recovered well with no complications or recurrence 1 year postoperatively. Our success
suggests that combined surgery may be an effective management for coexistence of Mooren’s
ulcer and a pterygium if conservative treatments fail. A corneal lenticule obtained by
SMILE can be used as the lamellar keratoplasty graft in such patients.
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Affiliation(s)
- Na He
- Department of Ophthalmology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wei Song
- Department of Ophthalmology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Ying Gao
- Department of Ophthalmology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Li M, Li M, Sun L, Han T, Ding L, Xiang J, Zhou X. In vivo confocal microscopic investigation of the cornea after autologous implantation of lenticules obtained through small incision lenticule extraction for treatment of hyperopia. Clin Exp Optom 2021; 101:38-45. [PMID: 28965357 DOI: 10.1111/cxo.12595] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 05/16/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Meiyan Li
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Meng Li
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Ling Sun
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Tian Han
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Lan Ding
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Jun Xiang
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Xingtao Zhou
- Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
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22
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Pant OP, Hao JL, Zhou DD, Pant M, Lu CW. Tectonic keratoplasty using small incision lenticule extraction-extracted intrastromal lenticule for corneal lesions. J Int Med Res 2020; 48:300060519897668. [PMID: 31975635 PMCID: PMC7113716 DOI: 10.1177/0300060519897668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study investigated an alternative approach for obtaining donor corneas for keratoplasty that can be used in nations with high corneal demand and high costs for treatment of non-healing ulcers or lesions. Methods Eighteen patients (18 eyes) who underwent tectonic keratoplasty using small incision refractive lenticule extraction (SMILE)-extracted lenticule were included. Data were recorded regarding age, corneal status, corneal lesion location and size, preoperative and postoperative visual acuity, lenticule layer, and additional medical history. Results Corneal thinning and corneal perforation in 13 and 5 patients, respectively, were treated with tectonic keratoplasty using SMILE-extracted lenticule. After tectonic keratoplasty, globe integrity was maintained in 16 of the 18 patients. The mean decimal visual acuity improved from 0.2555±0.3326 preoperatively to 0.3303±0.3487 at the final follow-up. Visual acuity improvement was greater in patients with corneal perforation than in patients with corneal thinning. In addition, visual acuity was most improved in patients with infratemporal lesions. Conclusion Tectonic keratoplasty using SMILE-extracted lenticule is a comparatively safe, effective, and reliable alternative approach for the treatment of corneal lesions.
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Affiliation(s)
- Om Prakash Pant
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Ji-Long Hao
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Dan-Dan Zhou
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Manju Pant
- Department of Ophthalmology, Faculty of Medicine, Thamassat University, Rangsit, Thailand
| | - Cheng-Wei Lu
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
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Chow SC, Yeung BYM. A Review on Different Tonometers for Intraocular Pressure Measurement After Photorefractive Keratectomy or Small Incision Lenticule Extraction. Clin Ophthalmol 2020; 14:3305-3323. [PMID: 33116382 PMCID: PMC7569048 DOI: 10.2147/opth.s278167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023] Open
Abstract
This paper aims to review different tonometers for intraocular pressure measurement in eyes after photorefractive keratectomy or small incision lenticule extraction. An Entrez Pubmed search was performed on July 19th, 2020. There were 32 eligible articles investigated in the use of tonometers or biomechanical properties of cornea in post photorefractive keratectomy eyes and 11 articles investigated in post small incision lenticule extraction eyes. Corvis ST and dynamic contour tonometry were found to be accurate for intraocular pressure measurement in post photorefractive keratectomy eyes. For post small incision lenticule extraction eyes, Corvis ST was found to be more accurate than other tonometers. Other tonometers such as Goldmann applanation tonometer, noncontact tonometry, Tonopen, ocular response analyzer can also be used in post photorefractive keratectomy or small incision lenticule extraction eyes in clinical practice; however, it is important for ophthalmologists to take note of the chances of discrepancies.
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Xeroudaki M, Thangavelu M, Lennikov A, Ratnayake A, Bisevac J, Petrovski G, Fagerholm P, Rafat M, Lagali N. A porous collagen-based hydrogel and implantation method for corneal stromal regeneration and sustained local drug delivery. Sci Rep 2020; 10:16936. [PMID: 33037282 PMCID: PMC7547117 DOI: 10.1038/s41598-020-73730-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
Biomaterials designed to replace the diseased cornea could be used to treat corneal blindness where human donor tissue is in short supply, but challenges are the integration of biomaterials with host tissue and cells, avoiding a rapid material degradation and maintaining corneal transparency. Additionally, implantation surgery often triggers an aggressive wound healing response that can lead to corneal thinning and opacity. Here, we report a collagen-based hydrogel with transparency and mechanical properties suitable for replacing a substantial portion of a damaged or diseased corneal stroma. The porous hydrogel permitted migration and population by host cells while maintaining transparency and thickness six months after surgical implantation in an in vivo model of human corneal surgery. With a novel hybrid surgical implantation technique inspired by LASIK refractive surgery, rapid wound healing occurred around implants to maintain biomaterial integrity, transparency and function. Host stromal cell repopulation and regeneration of host epithelium and nerves were observed, as necessary steps towards corneal regeneration. Finally, as a proof-of-principle, the hydrogel loaded with a neuroregenerative drug achieved sustained slow-release drug delivery in vitro. The proposed hydrogel and novel implantation technique together represent a therapeutic approach with translational potential for replacing and regenerating diseased corneal stromal tissue.
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Affiliation(s)
- Maria Xeroudaki
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Muthukumar Thangavelu
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, 58185, Linköping, Sweden
- LinkoCare Life Sciences AB, 58330, Linköping, Sweden
| | - Anton Lennikov
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | | | - Jovana Bisevac
- Department of Ophthalmology, Centre for Eye Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Centre for Eye Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Fagerholm
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Mehrdad Rafat
- Department of Biomedical Engineering, Linköping University, 58185, Linköping, Sweden.
- LinkoCare Life Sciences AB, 58330, Linköping, Sweden.
| | - Neil Lagali
- Department of Ophthalmology, Institute for Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden.
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
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Singhal D, Nagpal R, Maharana PK, Sinha R, Agarwal T, Sharma N, Titiyal JS. Surgical alternatives to keratoplasty in microbial keratitis. Surv Ophthalmol 2020; 66:290-307. [PMID: 32866469 DOI: 10.1016/j.survophthal.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
Penetrating keratoplasty is often required in microbial keratitis not responding to the standard treatments available or the development of complications like corneal perforation. Performing keratoplasty in microbial keratitis has several challenges, the major ones being the availability of donor corneal tissue and the poor success of the corneal graft performed in such a setting. For overcoming these challenges, several alternatives to keratoplasty have been described. Broadly, these options could be categorized into autologous tissues such as conjunctival and tenon tissue, synthetic products like tissue adhesives and therapeutic contact lenses, or biological tissues like amniotic membrane graft. These alternative modalities are not universal. They have their specific indications in microbial keratitis. Most of these alternatives are useful only for small corneal perforations. While autologous tissues are cost-effective and readily available, lack of tectonic support is a significant limitation. Tissue adhesives are excellent alternatives in terms of tectonic support, but surface irregularity and tissue reaction are their potential limitations. The amniotic membrane is useful for small corneal perforations, but availability, cost, and poor tectonic support restrict its use. Herein, we discuss these various alternatives to keratoplasty in microbial keratitis, their indications, advantages, disadvantages, and the various techniques of performing these procedures.
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Affiliation(s)
- Deepali Singhal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nagpal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajesh Sinha
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Agarwal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Zhao J, Liu R, Shen Y, Zhang X, Zhao Y, Xu H, Xu Y, Zhou X. Two-year observation of morphologic and histopathologic changes in the monkey cornea following small incision allogenic lenticule implantation. Exp Eye Res 2020; 192:107935. [DOI: 10.1016/j.exer.2020.107935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/28/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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Riau AK, Liu YC, Yam GH, Mehta JS. Stromal keratophakia: Corneal inlay implantation. Prog Retin Eye Res 2020; 75:100780. [DOI: 10.1016/j.preteyeres.2019.100780] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/28/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022]
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Application of the SMILE-derived lenticule in therapeutic keratoplasty. Int Ophthalmol 2019; 40:689-695. [PMID: 31754892 DOI: 10.1007/s10792-019-01229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To observe the clinical efficacy of the small incision lenticule extraction (SMILE)-derived lenticule patch graft in therapeutic keratoplasty, especially for the treatment of corneal microperforation or partial-thickness corneal defects. METHODS Corneal lenticule obtained from SMILE surgery with diameter greater than 6.5 mm and thickness greater than 100 μm was preserved in a balanced salt solution (Alcon Laboratories, Fort Worth, TX) containing 50 mg/mL penicillin, 50 mg/mL streptomycin, 100 mg/mL neomycin, and 2.5 mg/mL amphotericin for at least 3 months. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the ulcer and to decide the thickness of the lenticule. Patients were followed up on day 1 and then at 1, 3, and 6 months postoperatively. RESULTS Corneal perforation or defects were successfully patched in all 17 eyes; 8 eyes (47%) exhibited improvement postoperative corrected distance visual acuity. During the follow-up period of 6 months, there was no evidence of infection, relapse, or perforation detected in all eyes. Lenticule grafts were attached by graft beds very well and remain clear through to the last follow-up checkup in all eyes treated. CONCLUSIONS The lenticule patch graft seems to serve as a safe, feasible, and inexpensive surgical option for the treatment of keratohelcosis or partial-thickness corneal defects, especially in small perforation and defects. There are hopeful signs that SMILE-derived lenticule becomes a potential graft for therapeutic keratoplasty.
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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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Abstract
The corneal stroma comprises 90% of the corneal thickness and is critical for the cornea's transparency and refractive function necessary for vision. When the corneal stroma is altered by disease, injury, or scarring, however, an irreversible loss of transparency can occur. Corneal stromal pathology is the cause of millions of cases of blindness globally, and although corneal transplantation is the standard therapy, a severe global deficit of donor corneal tissue and eye banking infrastructure exists, and is unable to meet the overwhelming need. An alternative approach is to harness the endogenous regenerative ability of the corneal stroma, which exhibits self-renewal of the collagenous extracellular matrix under appropriate conditions. To mimic endogenous stromal regeneration, however, is a challenge. Unlike the corneal epithelium and endothelium, the corneal stroma is an exquisitely organized extracellular matrix containing stromal cells, proteoglycans and corneal nerves that is difficult to recapitulate in vitro. Nevertheless, much progress has recently been made in developing stromal equivalents, and in this review the most recent approaches to stromal regeneration therapy are described and discussed. Novel approaches for stromal regeneration include human or animal corneal and/or non-corneal tissue that is acellular or is decellularized and/or re-cellularized, acellular bioengineered stromal scaffolds, tissue adhesives, 3D bioprinting and stromal stem cell therapy. This review highlights the techniques and advances that have achieved first clinical use or are close to translation for eventual therapeutic application in repairing and regenerating the corneal stroma, while the potential of these novel therapies for achieving effective stromal regeneration is discussed.
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Affiliation(s)
- Neil Lagali
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
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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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Chen Y, Yin YW, Zhao Y, Wu XY, Young K, Song WT, Xia XB, Wen D. Differentiation of human embryonic stem cells derived mesenchymal stem cells into corneal epithelial cells after being seeded on decellularized SMILE-derived lenticules. Int J Ophthalmol 2019; 12:717-724. [PMID: 31131228 DOI: 10.18240/ijo.2019.05.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/27/2019] [Indexed: 12/14/2022] Open
Abstract
AIM To evaluate the feasibility of mesenchymal stem cells (MSCs) to differentiate into corneal epithelial cells after being seeded on the decellularized small incision lenticule extraction (SMILE)-derived lenticules. METHODS The fresh lenticules procured from patients undergoing SMILE for the correction of myopia were decellularized. The MSCs were subsequently cultivated on those denuded lenticules. The MSCs without lenticules were used as a control. The proliferation activity of the MSCs after seeding 24h was quantitatively determined with the Cell Counting Kit-8 (CCK-8) assay. Immunofluorescence staining and quantitative reverse transcription polymerase chain reaction (qRT-PCR) were used to assess the marker expression in differentiated MSCs. RESULTS The data showed that both fresh and decellularized lenticules could significantly promote the proliferation of MSCs, compared to that in control (P=0.02 for fresh lenticules, P=0.001 for decellularize ones, respectively). The MSCs seeded on both lenticules were positive for cytokeratin 3 (CK3) staining. The expression of CK3 increased 5-fold in MSCs seeded on fresh lenticules and 18-fold on decellularized ones, compared to that in control. There was a significant difference in the expression of CK3 in MSCs seeded on fresh and decellularized lenticules (P<0.001). The expression of CK8 and CK18 was similar in pure MSCs and MSCs seeded on fresh lenticules (P>0.05), while the expression of these markers was decreased in MSCs seeded on decellularized ones. CONCLUSION These results suggest that the decellularized lenticules might be more suitable for MSCs to differentiate into corneal epithelial cells, which offers the prospect of a novel therapeutic modality of SMILE-derived lenticules in regenerative corneal engineering.
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Affiliation(s)
- Yao Chen
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Ye-Wei Yin
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Yang Zhao
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Xiao-Ying Wu
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Kelly Young
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, Florida 33125, USA
| | - Wei-Tao Song
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Xiao-Bo Xia
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Dan Wen
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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Pant OP, Hao JL, Zhou DD, Lu CW. Tectonic keratoplasty using femtosecond laser lenticule in pediatric patients with corneal perforation secondary to blepharokeratoconjunctivitis: a case report and literature review. J Int Med Res 2019; 47:2312-2320. [PMID: 30971148 PMCID: PMC6567768 DOI: 10.1177/0300060519841163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Blepharokeratoconjunctivitis secondary to ocular demodicosis in the pediatric population is often neglected and may result in a serious sight-threatening condition. In severe cases, it can lead to corneal perforation necessitating urgent corneal transplantation. However, the shortage and high cost of donor corneas is the foremost limitation of keratoplasty in developing countries. Small-incision lenticule extraction is an advanced flapless femtosecond laser refractive procedure in which an intrastromal corneal lenticule is detached and removed to correct myopia and myopic astigmatism. We herein describe a technique in which lenticules are used for the management of corneal perforation secondary to Demodex-induced blepharokeratoconjunctivitis. The lenticule was sutured over the site of the perforated cornea using 10-0 interrupted nylon sutures. The globe integrity was maintained with a good visual outcome. Thus, tectonic keratoplasty using small-incision lenticule extraction appears to be a safe, cost-effective, and reliable alternative method for the management of corneal perforation secondary to blepharokeratoconjunctivitis.
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Affiliation(s)
- Om Prakash Pant
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ji-Long Hao
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Dan-Dan Zhou
- 2 Department of Radiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Cheng-Wei Lu
- 1 Department of Ophthalmology, the First Hospital of Jilin University, Changchun, Jilin Province, China
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Corneal remodelling and topography following biological inlay implantation with combined crosslinking in a rabbit model. Sci Rep 2019; 9:4479. [PMID: 30872596 PMCID: PMC6418097 DOI: 10.1038/s41598-019-39617-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
Implantation of biological corneal inlays, derived from small incision lenticule extraction, may be a feasible method for surgical management of refractive and corneal diseases. However, the refractive outcome is dependent on stromal remodelling of both the inlay and recipient stroma. This study aimed to investigate the refractive changes and tissue responses following implantation of 2.5-mm biological inlays with or without corneal collagen crosslinking (CXL) in a rabbit model. Prior to implantation, rotational rheometry demonstrated an almost two-fold increase in corneal stiffness after CXL. After implantation, haze gradually subsided in the CXL-treated inlays (p = 0.001), whereas the untreated inlays preserved their clarity (p = 0.75). In-vivo confocal microscopy revealed reduced keratocyte cell count at the interface of the CXL inlays at week 8. Following initial steepening, regression was observed in anterior mean curvature from week 1 to 12, being most prominent for the non-CXL subgroups (non-CXL: -12.3 ± 2.6D vs CXL: -2.3 ± 4.4D at 90 μm depth, p = 0.03; non-CXL: -12.4 ± 8.0D vs CXL: -5.0 ± 4.0D at 120 μm depth, p = 0.22). Immunohistochemical analysis revealed comparable tissue responses in CXL and untreated subgroups. Our findings suggest that CXL of biological inlays may reduce the time before refractive stabilization, but longer postoperative steroid treatment is necessary in order to reduce postoperative haze.
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Li M, Yang D, Zhao F, Han T, Li M, Zhou X, Ni K. Thirty-month results after the treatment of post-LASIK ectasia with allogenic lenticule addition and corneal cross-linking: a case report. BMC Ophthalmol 2018; 18:294. [PMID: 30419866 PMCID: PMC6233277 DOI: 10.1186/s12886-018-0967-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/01/2018] [Indexed: 11/18/2022] Open
Abstract
Background To report a first case of lenticule addition and corneal cross-linking for post-LASIK ectasia with associated corneal thinning. Case presentation Lenticule addition followed by corneal cross-linking was performed on the left eye of a patient with post-LASIK ectasia. Postoperatively, the corneal power and elevation were stable with a remarkable improvement in corneal thickness, and the lenticule had merged with the adjacent corneal stroma at 30 months follow-up. The patient’s corrected distance visual acuity gained two lines. Conclusions This case provides a potential treatment option for patients with keratectasia and keratoconus in association with thin corneal thickness (less than 400 μm) and may provide the benefit of delaying or avoiding the need for keratoplasty, which has its own associated complications and is limited by the availability of donor corneas.
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Affiliation(s)
- Meiyan Li
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Dong Yang
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Feng Zhao
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Tian Han
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Meng Li
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Xingtao Zhou
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Katherine Ni
- School of Medicine, New York University, New York, USA
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Li M, Zhao F, Li M, Knorz MC, Zhou X. Treatment of Corneal Ectasia by Implantation of an Allogenic Corneal Lenticule. J Refract Surg 2018; 34:347-350. [DOI: 10.3928/1081597x-20180323-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
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Pant OP, Hao JL, Zhou DD, Wang F, Lu CW. A novel case using femtosecond laser-acquired lenticule for recurrent pterygium: case report and literature review. J Int Med Res 2018; 46:2474-2480. [PMID: 29658366 PMCID: PMC6023051 DOI: 10.1177/0300060518765303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Small incision lenticule extraction (SMILE) is a minimally invasive, safe and flapless femtosecond laser technique used mainly to correct myopia through extraction of a corneal lenticule. Lenticules obtained in this way are transparent and of high quality, and thus, can be used to treat other corneal diseases. A 65-year-old male patient presented with recurrent pterygium complicated by thin cornea. The patient was treated surgically using a SMILE-extracted lenticule to avoid further complications and to maintain eyeball integrity. The lenticule was sutured over the thin section of cornea using 10-0 interrupted nylon sutures and enclosed by a single layer of amniotic membrane. The patient was evaluated using slit-lamp biomicroscopy and anterior-segment optical-coherence tomography. During an 8-month follow-up, the graft remained intact with no sign of rejection and corneal thickness was maintained. Tectonic keratoplasty using a SMILE-extracted lenticule appears to be a safe, cost-effective and reliable method for treating thin cornea due to repeated surgeries for recurrent pterygium. This is the first case of recurrent pterygium complicated by thin cornea managed surgically using a SMILE-extracted lenticule.
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Affiliation(s)
- Om Prakash Pant
- 1 Department of Ophthalmology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ji-Long Hao
- 1 Department of Ophthalmology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Dan-Dan Zhou
- 2 Department of Radiology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Fan Wang
- 1 Department of Ophthalmology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Cheng-Wei Lu
- 1 Department of Ophthalmology, First Hospital of Jilin University, Changchun, Jilin Province, China
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Femtosecond Laser-Assisted Small Incision Endokeratophakia Using a Xenogeneic Lenticule in Rhesus Monkeys. Cornea 2018; 37:354-361. [PMID: 29408829 DOI: 10.1097/ico.0000000000001470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of xenogeneic endokeratophakia in rhesus monkeys and to explore the effects of a concave lenticule on refractive power. METHODS Three adult New Zealand white rabbits and 6 healthy rhesus monkeys were used. The xenogenic concave grafts were created from the rabbits using a modified small incision lenticule extraction technique; after being cryopreserved in glycerol for 1 week, the grafts were implanted into the monkey recipient corneas. Spherical equivalent (SE), central corneal thickness, and keratometry curvature were assessed preoperatively, 1 week, 1, 4 and 6 months postoperatively. The quality of the xenogenic graft was also assessed by slit-lamp microscopy, in vivo confocal microscopy, and optical coherence tomography with anterior segment imaging. RESULTS The graft appeared to be swollen a day after the operation but reduced considerably after a week. A trend of a lower refractive power (hyperopic shift) was demonstrated in relation to the SE after concave graft implantation. The mean SE increased from -0.60 ± 1.31 (median -0.69, interquartile range -1.00 to 0.50) preoperatively to 0.75 ± 1.27 (median 1.38, interquartile range -0.25 to 1.63) at 1 month postoperatively (P = 0.01). Central corneal thickness was significantly thicker each time after surgery compared with that recorded preoperatively (P < 0.01). The anterior and posterior interface between the graft and stroma was visible during the study. Corneal nerve regeneration was evident at 6 months postoperatively. The xenogeneic concave graft was stable and transparent at follow-up. Severe adverse events or evidence of a rejection response were not observed. CONCLUSIONS Femtosecond laser-assisted small incision endokeratophakia using a xenogeneic corneal lenticule seems to be feasible and safe, which may provide a new method for myopia correction and keratoconus treatment.
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Zhao J, Zhao F, Huang J, Xu H, Chen Y, Zhou X. Two-Year Outcome of a Patient Treated With Phototherapeutic Keratectomy and Autologous SMILE Lenticule Transplantation for Flap-Related Complications Following LASIK. J Refract Surg 2018; 34:281-285. [PMID: 29634844 DOI: 10.3928/1081597x-20180130-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a patient with flap complications after LASIK who was subsequently treated using phototherapeutic keratectomy (PTK) and an autologous lenticule transplant obtained via small incision lenticule extraction (SMILE). METHODS A 23-year-old man experienced free flap and partial flap loss in the left eye following LASIK, resulting in corneal stroma opacity 1 month later. The manifest refraction was -3.25 diopters sphere (DS)/-0.50 diopters cylinder (DC) × 100° in the right eye and +2.50 DS/-1.25 DC × 155° in the left eye. His left eye was treated with PTK and transplantation of an autologous lenticule obtained from his right eye using the SMILE procedure. RESULTS At the 2-year follow-up visit, the uncorrected distance visual acuity of the left eye had improved from 20/100 to 20/22 and the corrected distance visual acuity had improved from 20/25 to 20/18. Central corneal thickness had increased from 464 to 499 µm. The mean keratometry value had decreased from 45.00 diopters (D) at the 1-month follow-up visit to 39.40 D at the 2-year follow-up visit. Optical coherence tomography examination revealed that the lenticule remained transparent and exhibited a visible demarcation line. CONCLUSIONS The transplantation of an autologous lenticule obtained via SMILE combined with PTK improved uncorrected and corrected acuity in this patient with flap loss after LASIK. [J Refract Surg. 2018;34(4):281-285.].
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Abd Elaziz MS, Zaky AG, El SaebaySarhan AR. Stromal lenticule transplantation for management of corneal perforations; one year results. Graefes Arch Clin Exp Ophthalmol 2017; 255:1179-1184. [PMID: 28409225 DOI: 10.1007/s00417-017-3645-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/05/2017] [Accepted: 03/20/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To study application of stromal lenticules extracted by femtolaser small incision lenticule extraction (SMILE) surgery as a surgical adjuvant to seal corneal perforations. METHODS Corneal stromal lenticules obtained through SMILE surgery with central thickness 100 μm or more were fixed over corneal perforation sites using 10-0 nylon interrupted stitches with an overlying single layer of amniotic membrane. Seven patients who had been followed up for a minimum of 12 months were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications were recorded throughout the follow up period. RESULTS Corneal perforations had successfully been sealed in all 7 patients; 3 patients (42.9%) exhibited improved postoperative BSCVA. During the follow-up period of one year, no signs of re-perforation or infections were detected in any patient. CONCLUSIONS These early findings suggest that the use of corneal stromal lenticules could be a safe and efficient surgical adjuvant for corneal perforation closure with potential clinical application, together with amniotic membrane, as relatively simple and low cost temporary measures to prepare perforated corneas for further definitive procedures.
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Affiliation(s)
| | - Adel Galal Zaky
- Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Jiang Y, Li Y, Liu XW, Xu J. A Novel Tectonic Keratoplasty with Femtosecond Laser Intrastromal Lenticule for Corneal Ulcer and Perforation. Chin Med J (Engl) 2017; 129:1817-21. [PMID: 27453231 PMCID: PMC4976570 DOI: 10.4103/0366-6999.186639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Small incision refractive lenticule extraction (SMILE) is an effective laser procedure that treats myopia. This research was to describe a novel approach to treat corneal ulcer or perforation using the corneal lenticules obtained from SMILE and to evaluate the safety and effectiveness of tectonic keratoplasty with femtosecond laser intrastromal lenticule (TEKIL). METHODS A total of twenty patients (22 eyes) were monitored for at least 6 months and were assessed using slit lamp microscopy, optical coherence tomography, and best-corrected visual acuity (BCVA). Postoperative complications throughout the study period were recorded. RESULTS Corneal ulcer in 14 patients (16 eyes) and corneal perforation in six patients (6 eyes) were treated with TEKIL. The patients were ten females and ten males, with a mean age of 58.5 ± 16.3 years (range: 16-81 years). In this study, the most causes of corneal ulcer or perforation were immunologic causes (54.5%). After TEKIL procedure, global integrity was achieved in all cases. No immune rejection or perforation was detected. The mean BCVA improved from 0.17 ± 0.20 preoperatively to 0.27 ± 0.25 postoperatively at the final follow-up (t = 2.095, P = 0.052). The postoperative BCVA improved in 12 eyes (54.5%) and maintained in nine eyes (40.9%). Vision function successfully maintained in all eyes (100%). In three cases, corneal ulcers were treated by reoperation of TEKIL at 3 months after the initial surgery for the reason that the residual corneal thickness was <250 μm. CONCLUSIONS TEKIL seems to be an effective treatment for corneal ulcer and perforation in the condition of emergency and donor shortage.
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Affiliation(s)
- Yang Jiang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Wei Liu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jing Xu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zhao J, Sun L, Shen Y, Tian M, Yao P, Zhou X. Using Donor Lenticules Obtained Through SMILE for an Epikeratophakia Technique Combined With Phototherapeutic Keratectomy. J Refract Surg 2016; 32:840-845. [DOI: 10.3928/1081597x-20160920-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/18/2016] [Indexed: 11/20/2022]
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Bruce AC, Cao Y, Henry C, Peirce SM, Laughon K. Preclinical Assessment of Safety and Efficacy of Fluorescent Dye for Detecting Dermal Injuries (the injuries were both abrasions and incision) in a Murine Model. J Forensic Sci 2016; 61:1493-1497. [DOI: 10.1111/1556-4029.13173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/29/2015] [Accepted: 01/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony C. Bruce
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Yiqi Cao
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Catherine Henry
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Shayn M. Peirce
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Kathryn Laughon
- School of Nursing; University of Virginia; PO Box 800826 Charlottesville VA 22903
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Yin H, Qiu P, Wu F, Zhang W, Teng W, Qin Z, Li C, Zhou J, Fang Z, Tang Q, Fu Q, Ma J, Yang Y. Construction of a Corneal Stromal Equivalent with SMILE-Derived Lenticules and Fibrin Glue. Sci Rep 2016; 6:33848. [PMID: 27651001 PMCID: PMC5030613 DOI: 10.1038/srep33848] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/05/2016] [Indexed: 01/17/2023] Open
Abstract
The scarcity of corneal tissue to treat deep corneal defects and corneal perforations remains a challenge. Currently, small incision lenticule extraction (SMILE)-derived lenticules appear to be a promising alternative for the treatment of these conditions. However, the thickness and toughness of a single piece of lenticule are limited. To overcome these limitations, we constructed a corneal stromal equivalent with SMILE-derived lenticules and fibrin glue. In vitro cell culture revealed that the corneal stromal equivalent could provide a suitable scaffold for the survival and proliferation of corneal epithelial cells, which formed a continuous pluristratified epithelium with the expression of characteristic markers. Finally, anterior lamellar keratoplasty in rabbits demonstrated that the corneal stromal equivalent with decellularized lenticules and fibrin glue could repair the anterior region of the stroma, leading to re-epithelialization and recovery of both transparency and ultrastructural organization. Corneal neovascularization, graft degradation, and corneal rejection were not observed within 3 months. Taken together, the corneal stromal equivalent with SMILE-derived lenticules and fibrin glue appears to be a safe and effective alternative for the repair of damage to the anterior cornea, which may provide new avenues in the treatment of deep corneal defects or corneal perforations.
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Affiliation(s)
- Houfa Yin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Peijin Qiu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Wu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Zhang
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenqi Teng
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenwei Qin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chao Li
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaojie Zhou
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhi Fang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiaomei Tang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiuli Fu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Ma
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yabo Yang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. Although the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye. RECENT FINDINGS There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Although there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer. SUMMARY Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient's situation. VIDEO ABSTRACT http://links.lww.com/COOP/A20.
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Affiliation(s)
- Sonal Tuli
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Application of the SMILE-Derived Glued Lenticule Patch Graft in Microperforations and Partial-Thickness Corneal Defects. Cornea 2016; 35:408-12. [DOI: 10.1097/ico.0000000000000741] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Piñero-Llorens DP, Murueta-Goyena Larrañaga A, Hanneken L. Visual outcomes and complications of small-incision lenticule extraction: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1131610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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