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Lin F, Han X, Liu S, Wei R, Zhou X, Li M. Lenticule Intrastromal Keratoplasty for the Correction of Iatrogenic High Hyperopia. Cornea 2024; 43:734-739. [PMID: 37824192 DOI: 10.1097/ico.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety, efficacy, and predictability of lenticule intrastromal keratoplasty (LIKE) for the correction of iatrogenic high hyperopia. METHODS Three patients (4 eyes) were referred to our department because of overcorrection of myopia induced by femtosecond laser-assisted in situ keratomileusis. All eyes exhibited hyperopia (between +4.00 and +8.00 D) and thin corneas ranging from 307 to 378 μm. Because of the regression of the use of laser ablation to correct high hyperopia and thin corneas, we initially adopted LIKE to correct iatrogenic high hyperopia in all 4 eyes. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, and anterior segment optical coherence tomography findings were recorded during each follow-up evaluation. RESULTS No postoperative complications, such as interface haze and opacification, were observed in the 4 eyes during each follow-up evaluation, with an average follow-up of 9.50 months. All eyes had significantly improved UDVA postoperatively. A total of 3 eyes achieved an UDVA of 20/25 or better while the other 1 eye had an UDVA of 20/40 postoperatively. In addition, 2 of the 4 eyes had a postoperative UDVA equal to or better than preoperative CDVA. No eyes lost any CDVA lines. All 4 eyes were within ±0.50 D of the spherical power (intended target of 0). The central corneal thickness and curvature of the anterior corneal surface in all 4 eyes increased postoperatively. Anterior segment optical coherence tomography revealed that the lenticule was transparent, with no wrinkles or offsets, during each follow-up evaluation. CONCLUSIONS LIKE for the correction of iatrogenic hyperopia has good efficacy and safety. Although an extremely thin cornea after overcorrection may not be suitable for hyperopic laser enhancement, LIKE is a good choice because of its good predictability and ability to restore the normal corneal structure.
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Affiliation(s)
- Feng Lin
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaosong Han
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Shengtao Liu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
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Wang Y, Zheng J, Guo Z, Fang X. Efficacy and safety of small-incision corneal intrastromal lenticule implantation for hyperopia correction: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1320235. [PMID: 38435392 PMCID: PMC10904476 DOI: 10.3389/fmed.2024.1320235] [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: 10/12/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose To assess the efficacy and safety of intrastromal lenticule implantation for the treatment of hyperopia. Methods A systematic search of PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Internet, and Wan Fang Database identified studies on small-incision intrastromal lenticule implantation for hyperopia correction until January 2023. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the retrospective research, and the Methodological Index for Non-randomized Studies (MINORS) was used to assess the quality of the prospective research. This study included postoperative visual outcomes, corneal morphology, and biomechanical outcomes. Results A total of 456 articles were identified, of which 10 were included in the meta-analysis. Ten single-arm studies involving 190 eyes were included. A meta-analysis demonstrated that corneal intrastromal lenticule implantation treatment significantly improved hyperopia. Uncorrected distance visual acuity (UDVA) significantly improved compared to the preoperative value (p = 0.027), corrected distance visual acuity showed no difference compared to the preoperative value (p = 0.27), and 87% eyes have no loss of one or more lines in the Snellen lines of CDVA (p < 0.00001). There was a significant difference between the spherical equivalent refractive (SE) and preoperative examination (p < 0.00001), 52% of eyes had ±0.5 diopters (D) postoperative SE (p < 0.00001), and 74% eyes had ±1.0 D postoperative SE (p < 0.00001). The central corneal thickness (CCT) increased by 72.68 μm compared to that preoperatively (p < 0.00001), and corneal curvature increased by 4.18D (p < 0.00001). The Q-value decreased by 0.82 (p < 0.00001), and higher-order aberration (HOA) decreased by 0.66 (p < 0.00001). Conclusion Small-incision intrastromal lenticule implantation may be an effective solution for correcting hyperopia. The effect of improved vision is significant, but further exploration is needed for changes in corneal biomechanics and long-term safety.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023432343.
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Affiliation(s)
- Yue Wang
- Ophthalmology, Liaoning Aier Eye Hospital, Shenyang, China
| | - Jingjing Zheng
- Ophthalmology, Liaoning Aier Eye Hospital, Shenyang, China
| | - Zuofeng Guo
- Ophthalmology, Liaoning Aier Eye Hospital, Shenyang, China
| | - Xuejun Fang
- Ophthalmology, Liaoning Aier Eye Hospital, Shenyang, China
- AIER School of Ophthalmology, Central South University, Changsha, 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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Abtahi MA, Beheshtnejad AH, Latifi G, Akbari-Kamrani M, Ghafarian S, Masoomi A, Sonbolastan SA, Jahanbani-Ardakani H, Atighechian M, Banan L, Nouri H, Abtahi SH. Corneal Epithelial Thickness Mapping: A Major Review. J Ophthalmol 2024; 2024:6674747. [PMID: 38205099 PMCID: PMC10776199 DOI: 10.1155/2024/6674747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.
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Affiliation(s)
| | | | - Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sadegh Ghafarian
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoomi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Laleh Banan
- Sunshine Coast University Hospital, Brisbane, Queensland, Australia
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ganesh S, Brar S, Chopra R. Lamellar surgeries with SMILE-derived lenticules. Taiwan J Ophthalmol 2024; 14:70-77. [PMID: 38654992 PMCID: PMC11034677 DOI: 10.4103/tjo.tjo-d-23-00171] [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: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Lamellar surgeries with SMILE lenticules are an evolving field of refractive surgery. This chapter intends to discuss the reported clinical results of using SMILE derived lenticules in terms of feasibility, safety and predictability; or the potential management of hyperopia, keratoconus, SMILE ectasia and presbyopia. MATERIALS AND METHODS Donor SMILE lenticules were prepared under microscope tocreate doughnut shaped lenticules. For hyperopia, this tissue was then inserted into afemtosecond laser enabled pocket created using VisuMax FS Laser at a depth of 160µm. For ectasia induced by keratoconus and post refractive procedure (SMILE), 0.23% riboflavin dye was instilled into the interface and then lenticule was inserted followed by exposure to UV-A radiation with total energy of 6.3 J. RESULTS Spherical equivalent (S.E.) of within ± 0.5 D was observed in 50% (n=21) eyes and within 1 D was seen in 71% eyes treated for hyperopia. A significant increase in the K mean anterior, central corneal thickness, Q-value and corneal aberrations was seen 2 weeks post-op. Clinical improvement in terms of S.E. and uncorrected distance visual acuity in eyes treated for ectasia after keratoconus and post refractive procedure (SMILE) was seen. CONCLUSION With the ample availability of SMILE- derived lenticules, researchers are exploring the possibility of using this tissue for the treatment of various refractive and corneal conditions.
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Affiliation(s)
- Sri Ganesh
- Nethradhama Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Nethradhama Eye Hospital, Bengaluru, Karnataka, India
| | - Riya Chopra
- Nethradhama Eye Hospital, Bengaluru, Karnataka, India
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Lin F, Liu S, Fu D, Zhang L, Wei R, Li M, Zhou X. Comparison of Visual Outcomes and Higher-order Aberrations Between FS-LASIK and SMI-LIKE for Moderate to High Hyperopia: A 2-Year Result. Cornea 2023; 42:1506-1512. [PMID: 37099670 PMCID: PMC10627543 DOI: 10.1097/ico.0000000000003283] [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: 09/01/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE The aim of the study was to evaluate and compare the long-term visual outcomes and higher-order aberrations (HOAs) between femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule intrastromal keratoplasty (SMI-LIKE) in the correction of moderate to high hyperopia. METHODS In this study, 16 subjects (20 eyes) underwent FS-LASIK and 7 subjects (10 eyes) underwent SMI-LIKE. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, mean keratometry (Km), anterior asphericity (Q), and HOAs preoperatively and 2 years postoperatively were obtained in both procedures. RESULTS The efficacy indices of the FS-LASIK group and the SMI-LIKE group were 0.85 ± 0.14 and 0.87 ± 0.17, respectively. The safety indices of the FS-LASIK and SMI-LIKE groups were 0.99 ± 0.15 and 1.08 ± 0.24, respectively. No significant difference in safety index or efficacy index was found between the FS-LASIK and SMI-LIKE groups (all P > 0.05). The correlation coefficient of the attempted versus achieved spherical equivalent postoperatively was 0.69 ( P < 0.01) and 0.89 ( P < 0.01) in the FS-LASIK group and SMI-LIKE groups, respectively. The front Km, negative Q value, negative spherical aberrations (SAs), coma, and total HOAs significantly increased postoperatively in the 2 groups ( P < 0.05). The FS-LASIK group had greater changes in Q value and SA postoperatively than the SMI-LIKE group ( P < 0.01). CONCLUSIONS SMI-LIKE had similar safety and efficacy to FS-LASIK in the correction of moderate to high hyperopia. However, SMI-LIKE may equip better visual quality postoperatively for its lower Q value and SA changes than FS-LASIK.
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Affiliation(s)
- Feng Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Shengtao Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Luoli Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudon University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; and
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
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Xie M, Deng Y, Wang L, Zhang X, Gong R, Tang J. Corneal lenticule implantation combined with PTK and PRK to correct hyperopia. J Fr Ophtalmol 2023; 46:e352-e357. [PMID: 37544781 DOI: 10.1016/j.jfo.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/15/2023] [Indexed: 08/08/2023]
Affiliation(s)
- M Xie
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Y Deng
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - L Wang
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - X Zhang
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - R Gong
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - J Tang
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China.
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Moshirfar M, Stoakes IM, Bruce EG, Ali A, Payne CJ, Furhiman D, Ronquillo YC, Hoopes PC. Allogenic Lenticular Implantation for Correction of Refractive Error and Ectasia: Narrative Review. Ophthalmol Ther 2023; 12:2361-2379. [PMID: 37516716 PMCID: PMC10442033 DOI: 10.1007/s40123-023-00765-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Intrastromal lenticule implantation is a promising treatment option for corneal pathologies, from refractive error to ectasia. In this narrative review, we intend to feature up-to-date literature supporting the use of lenticular tissue, a compelling method that can be customized for a variety of applications, providing an additional source of donor tissue for treating corneal diseases. METHODS We searched databases PubMed, Mendeley, and Scopus last accessed 10 May 2023, for literature on stromal lenticules and narrowed based on relevance. Review articles, animal studies, ex vivo studies, and book chapters were excluded, while assessable and relevant articles published in English were included. RESULTS Storage methods from using fresh lenticules to dehydration have proven successful, with cryopreservation maintaining structure and cellular viability for up to 10 years. Successful use of lenticules for treatment of numerous pathologies including corneal ectasias, hyperopia, and presbyopia with additional insight into the treatment of corneal ulcers and perforations are highlighted in this narrative review. CONCLUSION Lenticular implantation is an innovative and advantageous treatment for various ocular pathologies, offering increased bioavailability, flexibility, and customization for patients. They can treat previously untreatable diseases and serve as a replacement for synthetic implants, with promising outcomes worldwide. Lenticular implantation has the potential to become a leading approach in ophthalmologic surgery. Further studies should aim to provide evidentiary support for a standardization of lenticule banking.
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Affiliation(s)
- Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT, USA.
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
| | - Isabella M Stoakes
- HDR Research Center, Hoopes Vision, Draper, UT, USA
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | | | - Amir Ali
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Carter J Payne
- HDR Research Center, Hoopes Vision, Draper, UT, USA
- Case Western Reserve School of Medicine, Cleveland, OH, USA
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Vautier A, Bourges JL, Gabison E, Chaventre F, Lefevre S, Toubeau D, Arnoult C, Albou-Ganem C, Boyer O, Muraine M. An Efficient Technique for the Long-term Preservation of SMILE Lenticules Using Desiccation. J Refract Surg 2023; 39:491-498. [PMID: 37449510 DOI: 10.3928/1081597x-20230609-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE To evaluate a desiccation protocol for the long-term preservation of human small incision lenticule extraction (SMILE) lenticules and to study their integration in an in vivo rabbit model. METHODS Lenticules were retrieved after SMILE procedures in patients, then desiccated according to a novel protocol. Histologic and electron microscopic analyses were performed. Six rabbit eyes received grafts with an inlay technique, which consisted of inserting a desiccated lenticule into a stromal pocket. Rabbits were killed at different times between 6 and 24 weeks. Rabbit corneas were analyzed using optical coherence tomography, histology, and DAPI staining. RESULTS Microscopic analysis of desiccated lenticules showed a preserved stromal architecture after rehydration. A decellularization of the lenticules after desiccation was observed without any chemical treatment. All rabbit corneas remained clear after grafting human lenticules and no rejection occurred. Optical coherence tomography showed regular lenticular implantation and no decrease in lenticule thickness. Histologic analysis showed no inflammatory infiltration around lenticules and no nuclear material inside lenticules after 6 months. CONCLUSIONS A favorable integration of desiccated human SMILE lenticules in rabbit corneas was observed. The refractive issue of lenticular implantation must be investigated next. Clinical trials are needed to evaluate the use of desiccated SMILE lenticules to treat hyperopia or keratoconus in humans. [J Refract Surg. 2023;39(7):491-498.].
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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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Liu S, Yu L, Zhao Y, Zhou X. Changes in the posterior corneal surface after femtosecond laser-assisted lenticule intrastromal keratoplasty (LIKE) performed into a pocket (SMI-LIKE) or under a flap (FS-LIKE). EYE AND VISION (LONDON, ENGLAND) 2023; 10:23. [PMID: 37122005 PMCID: PMC10150533 DOI: 10.1186/s40662-023-00337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/16/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND To compare the changes in posterior corneal surface after small-incision lenticule intrastromal keratoplasty (SMI-LIKE) and femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) for hyperopia correction. METHODS In this prospective comparative randomized study, 23 eyes with hyperopia were recruited. Eyes were categorized into two groups-SMI-LIKE group (11 eyes) and FS-LIKE group (12 eyes). Lenticules from myopia small incision lenticule extraction were implanted into a pocket (SMI-LIKE group) or at a depth of 100 µm under a flap (FS-LIKE group). Posterior corneal elevations in the center, mid-periphery, and periphery, as well as mean keratometry of the posterior corneal surface (Kmb) were measured using a Pentacam over a three-month follow-up. RESULTS All surgeries were completed successfully and no complications occurred. At one day postoperatively, there was a slight backward change with SMI-LIKE and a forward change with FS-LIKE in the central region of the posterior corneal elevation. Conversely, the peripheral area showed forward displacement in SMI-LIKE and an apparent backward change in FS-LIKE. The mid-peripheral regions manifested a backward change after the procedure throughout the entire follow-up in both groups. Kmb exhibited flattening at one month postoperatively and subsequently returned to its original level at three months after SMI-LIKE while in FS-LIKE, Kmb steepened after lenticule implantation with a significant change noted at one day postoperatively (P = 0.001). CONCLUSIONS Posterior corneal surface after SMI-LIKE and FS-LIKE exhibited different change patterns in various corneal regions, with the most prominent change occurring at one day postoperatively during the three-month follow-up. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-ONC-16008300. Registered on Apr 18th, 2016. http://www.chictr.org.cn/edit.aspx?pid=14090&htm=4.
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Affiliation(s)
- Shengtao Liu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Lanhui Yu
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
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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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Liu S, Zhao Y, Zhao J, Zhang X, Li M, Zhou X. Achieved Lenticule Diameter and Functional Optical Zone in Hyperopic Eyes After Lenticule Intrastromal Keratoplasty. J Refract Surg 2022; 38:791-796. [PMID: 36476299 DOI: 10.3928/1081597x-20221107-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate achieved lenticule diameter (ALD) and functional optical zone (FOZ) following femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) or small incision lenticule intrastromal keratoplasty (SMI-LIKE). METHODS Small incision lenticule extraction (SMILE)-derived human lenticules were placed on the surface of a contact glass (CG) and model eye (ME). Ex vivo ALDs were assessed at different hydration times. The ALD and FOZ were obtained using optical coherence tomography and Scheimpflug tomography at 6 months after lenticule implantation. RESULTS At 1 hour after hydration, lenticules achieved a slightly larger CG-loading ALD (6.63 ± 0.07 mm) and similar ME-loading ALD (6.53 ± 0.07 mm) as compared to a programmed optical zone (POZ) of 6.5 mm (P < .001). At 6 months after surgery, FS-LIKE with a POZ of 6.5 mm obtained an ALD of 6.20 ± 0.21 mm, which was larger than SMI-LIKE with a POZ of 6.64 mm (5.90 ± 0.14 mm, P = .001). The mean FOZ diameters were 5.33 ± 0.28 and 5.11 ± 0.14 mm for the FS-LIKE and SMI-LIKE groups, respectively (P = .022). The absence of significant differences in the ALD and FOZ among the different meridians indicated that the achieved lenticule and optical zone shapes were circular. CONCLUSIONS An accurate lenticular size could be obtained from SMILE, and FS-LIKE could achieve a larger FOZ than SMI-LIKE, attributed to attaining a larger ALD. [J Refract Surg. 2022;38(12):791-796.].
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Yu N, Chen S, Yang X, Hou X, Wan L, Huang Y, Qiu J, Li Y, Zheng H, Wei H, Zeng C, Lei L, Chen P, Yang Y, Quan D, Zhuang J, Yu K. Comparison of fresh and preserved decellularized human corneal lenticules in femtosecond laser-assisted intrastromal lamellar keratoplasty. Acta Biomater 2022; 150:154-167. [PMID: 35896137 DOI: 10.1016/j.actbio.2022.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
Substantial evidence has demonstrated the application of fresh and decellularized human corneal lenticules from increasing myopic surgeries. Further preservation of decellularized corneal lenticules would extend its clinical application. However, whether fresh and preserved decellularized lenticules have the same effects in vivo, including refractive correction, remains unclear. Here, we made comprehensive comparisons between fresh human lenticules (FHLs) and preserved decellularized human lenticules (DHLs). Another group of decellularized lenticules was combined with crosslinking for potential keratoconus therapy. Optical transparency, biomechanical properties, and fibrillar ultrastructure were analyzed to evaluate the DHLs and crosslinked DHLs (cDHLs) in vitro. The DHLs retained high transparency and regular ultrastructure, with genetic materials mostly being eliminated. The strength of lenticules in the cDHL group was markedly increased by crosslinking. Moreover, after storage in glycerol for 3 months, the lenticules were reimplanted into rabbit corneal lamellar pockets assisted by a femtosecond laser. The rabbits were followed for another 3 months. There were no obvious rejective complications in any of the three groups. From 1 week to 3 months postoperatively, the host corneas of the FHL group remained highly transparent, while slight hazes were observed in the DHL group. However, the corneas of the cDHL group displayed opacity throughout the 3-month postoperative period. Furthermore, all the lenticules could effectively induce corneal steepening and refractive changes. Taken together, our data indicated that FHLs are ideal inlay products, whereas preserved DHLs could be an alternative for intrastromal lamellar keratoplasty. Our study provides new insights into the clinical application of human lenticule recycling. STATEMENT OF SIGNIFICANCE: : Currently, substantial evidence has demonstrated the application of fresh and decellularized human corneal lenticules from increasing myopic surgeries. Further preservation of decellularized lenticules would extend its clinical application. However, whether fresh and preserved decellularized lenticules have the same effects in vivo, including refractive correction, remains unclear. Herein, we decellularized human lenticules with or without mechanically strengthened crosslinking. After storage in glycerol for 3 months, the lenticules were reimplanted into rabbit corneas. Comprehensive comparisons were performed among fresh human lenticules (FHLs), decellularized human lenticules (DHLs) and crosslinked DHLs. Our study indicated that FHLs are ideal inlay products, whereas preserved DHLs could be an alternative for intrastromal lamellar keratoplasty. Our study provides new insights into the clinical application of human lenticule recycling.
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Affiliation(s)
- Na Yu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Shuilian Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Xifeng Yang
- PCFM Lab, GD HPPC Lab, School of Chemistry, and Guangdong Functional Biomaterials Engineering Technology Research Center, School of Materials Science and Engineering, Sun Yat-Sen University, P. R. China 510275
| | - Xiangtao Hou
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Linxi Wan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Yuke Huang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Jin Qiu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Yan Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Hua Zheng
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Han Wei
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Chenguang Zeng
- Guangzhou Sun-shing Biotech Co., Ltd, P. R. China 510060
| | - Lei Lei
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Pei Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Ying Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060
| | - Daping Quan
- PCFM Lab, GD HPPC Lab, School of Chemistry, and Guangdong Functional Biomaterials Engineering Technology Research Center, School of Materials Science and Engineering, Sun Yat-Sen University, P. R. China 510275.
| | - Jing Zhuang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060.
| | - Keming Yu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, P. R. China 510060.
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Comparison of the Effects of Temperature and Dehydration Mode on Glycerin-Based Approaches to SMILE-Derived Lenticule Preservation. Cornea 2022; 41:470-477. [PMID: 35244627 PMCID: PMC8895973 DOI: 10.1097/ico.0000000000002846] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Abstract
Supplemental Digital Content is Available in the Text. The aim of this study was to explore the optimal method of small-incision lenticule extraction (SMILE)-derived lenticules, subjected to long-term preservation using glycerol, under a range of temperatures, and using an array of dehydration agents.
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Liu S, Zhang X, Yu L, Li M, Zhou X. Comparison of Optical Zone Decentration Following FS-LIKE and SMI-LIKE for Correcting Hyperopia. J Refract Surg 2022; 38:184-190. [PMID: 35275003 DOI: 10.3928/1081597x-20211213-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate optical zone decentration following femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) or small incision lenticule intrastromal keratoplasty (SMI-LIKE) for correcting hyperopia. METHODS This study analyzed decentration values obtained from optical coherence tomography (OCT) and tangential topography difference maps of 23 eyes (18 patients) undergoing FS-LIKE (n = 12) or SMI-LIKE (n = 11) via the concentric centration method. Total higher order aberrations (HOAs) and component aberrations were measured preoperatively and 6 months postoperatively. RESULTS The mean optical zone decentration was 0.27 ± 0.08 and 0.39 ± 0.16 mm for the FS-LIKE and SMI-LIKE groups, respectively (P = .039). A significant difference was noted in lenticule decentration between the two groups (0.18 vs 0.37 mm), whereas no significant difference was observed in stromal bed (pocket) decentration between the two groups (0.10 vs 0.12 mm). Six months after surgery, the spherical equivalent showed a reduction of 6.14 ± 2.44 and 6.10 ± 1.79 diopters (D) for the two groups, respectively (P = .971), whereas the surgically induced astigmatism was 0.68 ± 0.49 and 1.56 ± 0.78 D for the two groups, respectively (P = .004). Furthermore, induction of HOAs in the SMI-LIKE group was significantly larger than that in the FS-LIKE group (P = .013). CONCLUSIONS FS-LIKE can yield improved treatment centration and less induction of total HOAs. [J Refract Surg. 2022;38(3):184-190.].
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Liu S, Zhang X, Zhou X. Toric Lenticule Implantation for Correction of Hyperopia and Astigmatism Following Small Incision Lenticule Intrastromal Keratoplasty With the Triple Marking Method. J Refract Surg 2022; 38:82-88. [DOI: 10.3928/1081597x-20211117-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wu J, Xiong L, Wang Z. Relifting Flap Enhancement Procedure After Primary Allogenic Refractive Lenticule Implantation. J Refract Surg 2021; 37:715-719. [PMID: 34661477 DOI: 10.3928/1081597x-20210712-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the results of a relifting flap enhancement procedure for correction of residual refractive error after primary lenticule intrastromal keratoplasty (LIKE). METHODS Case report. RESULTS One year after a LIKE procedure in the left eye, the patient (uncorrected distance visual acuity [UDVA]: 20/25; corrected distance visual acuity [CDVA]: 20/20; manifest refraction: -1.00 +1.00 × 105°) underwent flap relifting. The WaveLight EX500 excimer laser platform (Alcon Laboratories, Inc) was used for the topography-guided enhancement procedure to correct the residual refractive error and corneal irregularities. During the 1-year follow-up period, the cornea remained clear, the UDVA increased to 20/20 (reaching the level of preoperative CDVA), and manifest refraction was -0.25 +0.75 × 90°. CONCLUSIONS The enhancement procedure described in this case report was effective for correction of residual refractive error and improvement of visual acuity following the LIKE procedure. The enhancement was stable for at least 15 months after the procedure. [J Refract Surg. 2021;37(10):715-719.].
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Riau AK, Boey KPY, Binte M Yusoff NZ, Goh TW, Yam GHF, Tang KF, Phua CSH, Chen HJ, Chiew YF, Liu YC, Mehta JS. Experiment-Based Validation of Corneal Lenticule Banking in a Health Authority-Licensed Facility. Tissue Eng Part A 2021; 28:69-83. [PMID: 34128385 DOI: 10.1089/ten.tea.2021.0042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the expected rise in patients undergoing refractive lenticule extraction worldwide, the number of discarded corneal stromal lenticules will increase. Therefore, establishing a lenticule bank to collect, catalog, process, cryopreserve, and distribute the lenticules (for future therapeutic needs) could be advantageous. In this study, we validated the safety of lenticule banking that involved the collection of human lenticules from our eye clinic, transportation of the lenticules to a Singapore Ministry of Health-licensed lenticule bank, processing, and cryopreservation of the lenticules, which, after 3 months or, a longer term, 12 months, were retrieved and transported to our laboratory for implantation in rabbit corneas. The lenticule collection was approved by the SingHealth Centralised Institutional Review Board (CIRB). Both short-term and long-term cryopreserved lenticules, although not as transparent as fresh lenticules due to an altered collagen fibrillar packing, did not show any sign of rejection and cytotoxicity, and did not induce haze or neovascularization for 16 weeks even when antibiotic and steroidal administration were withdrawn after 8 weeks. The lenticular transparency progressively improved and was mostly clear after 4 weeks, the same period when we observed the stabilization of corneal hydration. We showed that the equalization of the collagen fibrillar packing of the lenticules with that of the host corneal stroma contributed to the lenticular haze clearance. Most importantly, no active wound healing and inflammatory reactions were seen after 16 weeks. Our study suggests that long-term lenticule banking is a feasible approach for the storage of stromal lenticules after refractive surgery.
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Affiliation(s)
- 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
| | - Kenny P Y Boey
- Group Laboratory Operations, Cordlife Group Limited, Singapore, Singapore
| | | | - Tze-Wei Goh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Gary H F Yam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kin F Tang
- Group Laboratory Operations, Cordlife Group Limited, Singapore, Singapore.,Singapore Laboratory, Cordlife Group Limited, Singapore, Singapore
| | | | - Hui-Jun Chen
- Singapore Laboratory, Cordlife Group Limited, Singapore, Singapore
| | - Yoke F Chiew
- Singapore Laboratory, Cordlife Group Limited, Singapore, Singapore
| | - 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.,Corneal and External Eye Disease Department, Singapore National Eye Centre, 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.,Corneal and External Eye Disease Department, Singapore National Eye Centre, Singapore, Singapore
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