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Liu Y, He Y, Deng Y, Wang L. Lenticule addition keratoplasty for the treatment of keratoconus: A systematic review and critical considerations. Indian J Ophthalmol 2024; 72:S167-S175. [PMID: 38271413 DOI: 10.4103/ijo.ijo_695_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/09/2023] [Indexed: 01/27/2024] Open
Abstract
Keratoconus is a corneal disorder characterized by the progressive thinning and bulging of the cornea. Currently, the major goal of management is to halt its progression, restore normal corneal strength, prevent acute complications, and save vision. Penetrating keratoplasty and deep anterior lamellar keratoplasty as conventional surgical methods for advanced keratoconus are limited by relatively high rates of immune intolerance, slow post-operational recovery, high costs, and shortage of donor corneas. Recently, the development of lenticule addition keratoplasty enables the restoration of corneal thickness simply by implanting a lenticule into the stromal pocket created with the femtosecond laser, which can originate from cadaver corneas or more appealing, be extracted from patients via a small-incision lenticule extraction (SMILE) surgery. As the first systematic review in this field, we critically review publications on lenticule addition keratoplasty and provide our perspectives on its clinical application and the focus of future research.
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Affiliation(s)
- Yanling Liu
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan He
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Chan JS, Han E, Lim CHL, Kurz AC, Shuman J, Liu YC, Riau AK, Mehta JS. Incisional surface quality of electron-beam irradiated cornea-extracted lenticule for stromal keratophakia: high nJ-energy vs. low nJ-energy femtosecond laser. Front Med (Lausanne) 2023; 10:1289528. [PMID: 38162883 PMCID: PMC10754972 DOI: 10.3389/fmed.2023.1289528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Corneal lenticules can be utilized as an additive material for stromal keratophakia. However, following extraction, they must be reimplanted almost immediately or cryopreserved in lenticule banks. Electron-beam (E-beam) irradiated corneas permit room-temperature storage for up to 2 years, enabling keratophakia to be performed on demand. This study aims to compare the performance of high nano Joule (nJ)-energy (VisuMax) and low nJ-energy (FEMTO LDV) femtosecond laser systems on the thickness consistency and surface quality and collagen morphology of lenticules produced from fresh and E-beamed corneas. Methods A total of 24 lenticules with -6.00 dioptre power were cut in fresh human donor corneas and E-beamed corneas with VisuMax and FEMTO LDV. Before extraction, the thickness of the lenticules was measured with anterior segment-optical coherence tomography (AS-OCT). The incisional surface roughness of extracted lenticules was analyzed using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Multiphoton microscopy was then used to assess the surface collagen morphometry. Results The E-beamed lenticules that were cut using FEMTO LDV were significantly thicker than the fresh specimens as opposed to those created with VisuMax, which had a similar thickness as the fresh lenticules. On the vertex, they were ∼11% thicker than the fresh lenticules. The surface roughness (Rq) of E-beamed lenticules incised with FEMTO LDV did not differ significantly from the fresh lenticules. This contrasted with the VisuMax-fashioned lenticules, which showed notably smoother surfaces (∼36 and ∼20% lower Rq on anterior and posterior surfaces, respectively) on the E-beamed than the fresh lenticules. The FEMTO LDV induced less cumulative changes to the collagen morphology on the surfaces of both fresh and E-beamed lenticules than the VisuMax. Conclusion It has been previously demonstrated that the low nJ-energy FEMTO LDV produced a smoother cutting surface compared to high nJ-energy VisuMax in fresh lenticules. Here, we showed that this effect was also seen in the E-beamed lenticules. In addition, lower laser energy conferred fewer changes to the lenticular surface collagen morphology. The smaller disparity in surface cutting quality and collagen disturbances on the E-beamed lenticules could be beneficial for the early visual recovery of patients who undergo stromal keratophakia.
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Affiliation(s)
- Jian S. Chan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Evelina Han
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Chris H. L. Lim
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Ophthalmology, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Jeremy Shuman
- Lions World Vision Institute, Tampa, FL, United States
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Andri K. Riau
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
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Meziane Elotmani A, Messerschmidt-Roth A, Nehme A, Müller HH, Sekundo W. Comparison of intraocular lens power calculation formulas with and without total keratometry and ray tracing in patients with previous myopic SMILE. J Cataract Refract Surg 2023; 49:467-473. [PMID: 36700932 DOI: 10.1097/j.jcrs.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the prediction error (PE) variance and absolute median PE of different intraocular lens (IOL) calculation formulas including last-generation formulas such as Barrett True-K with K, Okulix and total keratometry (TK)-based calculations with Haigis, and Barrett True-K in a simulation model in post-small-incision lenticule extraction (SMILE) eyes. SETTINGS Department of Ophthalmology, University Hospital Marburg, Marburg, Germany. DESIGN Prospective study. METHODS Preoperative measurements included IOL power calculation before and after SMILE surgery. The target refraction was set to be the lowest myopic refractive error in pre-SMILE eyes. The IOL power targeting at the lowest myopic refractive error in pre-SMILE eyes was selected for the post-SMILE IOL calculation of the same eye. The difference between the predicted refraction of pre- and post-SMILE eyes with the same IOL power was defined as IOL difference. The refractive change induced by SMILE was defined as the difference between preoperative and postoperative manifest refraction. RESULTS 98 eyes from 49 patients underwent bilateral myopic SMILE. The PE variance of Okulix was not significantly different compared with Barrett True-K with TK ( P = .471). The SDs of the mean PEs were ±0.413 D (Haigis-TK), ±0.453 D (Okulix), ±0.471 D (Barrett True-K with TK), ±0.556 D (Haigis-L), and ±0.576 D (Barrett True-K with K). The mean absolute PE was 0.340 D, 0.353 D, 0.404 D, 0.511 D, and 0.715 D for Haigis-TK, Okulix, Barrett True-K with TK, Barrett True-K with K, and Haigis-L, respectively. The highest percentage of eyes within ±0.50 D was achieved by Okulix, followed by Haigis-TK, Barrett True-K with TK, Barrett True-K with K, and Haigis-L. CONCLUSIONS Results suggest that Haigis in combination with TK, Okulix, and Barrett True-K with and without TK offer good options for accurate IOL power calculation after SMILE. Haigis-L showed a tendency for myopic shift in eyes after previous SMILE.
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Affiliation(s)
- Anouar Meziane Elotmani
- From the Department of Ophthalmology, University Hospital Marburg (UKGM), Philipps University of Marburg, Marburg, Germany (Elotmani, Messerschmidt-Roth, Nehme, Sekundo); Institute of Medical Bioinformatics and Biostatistics, Philipps University of Marburg, Marburg, Germany (Müller)
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Liu X, Liu C, Lin H, Shao Y, Zhang L, Bi Y. An optional surgical technique for obtaining lamellar donor grafts: a pilot study. BMC Ophthalmol 2022; 22:137. [PMID: 35337290 PMCID: PMC8957127 DOI: 10.1186/s12886-022-02371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the surface quality and thickness uniformity of lamellar donor grafts using an optional surgical technique called reversed manual dissection (RMD) in porcine corneas. Methods Twenty-four paired porcine corneas (48 eyes) were numbered 1 to 24 and divided into 6 groups. All left corneas were assigned to conventional manual dissection (CMD), and all right corneas were assigned to RMD. Each group contained 8 corneas. For Groups I, II, and III, 30, 50, and 70% of the entire corneal thickness was dissected using CMD. For groups IV, V, and VI, 70, 50, and 30% of the entire corneal thickness was dissected using RMD. The residual stromal thickness was examined by anterior segment optical coherence tomography (ASOCT) to assess the thickness uniformity and scanning electron microscopy (SEM) to assess the surface quality. Results The thickness uniformity of the lamellar grafts between each paired group was not significantly different (p > 0.05). The qualitative surface roughness grading (QiSR) evaluated by masked observers through SEM was significantly higher in the RMD groups (p < 0.001). The quantitative surface roughness grading (QnSR) acquired from the Mountains software was significantly lower in the RMD groups (p < 0.001). Conclusions RMD is an optional surgical technique for obtaining porcine lamellar grafts. The thickness uniformity of RMD is comparable to that of CMD, and a smoother surface with fewer ridges and roughness is achieved compared to CMD.
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Affiliation(s)
- Xin Liu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200092, China.,Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Chunyu Liu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200092, China
| | - Hui Lin
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200092, China
| | - Yuting Shao
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200092, China
| | - Li Zhang
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200092, China.
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, No. 389, Xincun Road, Putuo District, Shanghai, 200092, China. .,Tongji Eye Institute, Tongji University School of Medicine, Shanghai, China.
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