PURPOSE: To investigate the potential benefit of keratoconus surgery using customized corneal stromal donor lenticules obtained from myopic small incision lenticule extraction (SMILE) surgery by femtosecond laser. METHODS: In this prospective, consecutive, non-comparative series of cases, 22 lenticules were obtained from 22 myopic patients who had SMILE with a lenticule central thickness of greater than 110 µm. The lenticules were implanted in 22 eyes with advanced keratoconus. The lenticules were customized for the purpose of the implantation with either a simple necklace or necklace-with-ring shape (compound form) depending on the corneal thickness and corneal topography configuration of the implanted keratoconic eyes. The lenticules were implanted into a 9.5-mm corneal lamellar pocket created by the femtosecond laser. Changes in densitometry, thickness, confocal microscopy, corrected distance visual acuity (CDVA), and endothelial cell density were investigated. RESULTS: Intrastromal lenticule implantation was successfully performed in all cases without any complication. Corneal thickness showed a mean enhancement of 100.4 µm at the thinnest point. On biomicroscopy, all corneas were clear at 1 year postoperatively and there was a significant improvement in corneal densitometry during the entire follow-up period. Confocal biomicroscopy showed collagen reactivation without any inflammatory features caused by the implanted fresh lenticules. CDVA improved from 0.70 to 0.49 logMAR ( P = .001) and keratometry decreased from 54.68 ± 2.77 to 51.95 ± 2.21 diopters ( P = .006). CONCLUSIONS: Customized SMILE lenticule implantation by femtosecond laser proved to be feasible, resulting in an improvement in vision, topography, and refraction in the implanted eyes. [ J Refract Surg . 2020;36(12):786–794.]

Purpose:To evaluate the clinical results of toric trifocal diffractive intraocular lens in eyes with cataract and mild keratoconus.Methods:Five keratoconus patients (10 eyes) that had bilateral AT LISA 939 implantation were selected and had followed in 3-time horizons of 1, 3, and 6 months. Patients were 46 to 65 years old age, corneal astigmatism of (2.00 D at 6.75 D) and cataract that all of them needed cataract surgery. The distance, intermediate and near visual acuities, defocus curve, ocular aberrations, contrast sensitivity, were measured as effectiveness criteria.Results:Average of binocular uncorrected distance visual acuity (UDVA) improved from 0.72 log MAR ± 0.11 (SD) to 0.04 ± 0.04 (P < 0.05) log MAR, average of uncorrected binocular intermediate visual acuity (UIVA) (80 cm) improved from 0.52 ± 0.07 log MAR to 0.14 ± 0.04 (P < 0.05) log MAR, and average of binocular uncorrected near visual acuity (UNVA) improved from 0.48 ± 0.09 log MAR to 0.02 ± 0.07 (P < 0.05) log MAR at 6 months, respectively. Contrast sensitivity testing showed acceptable results, the binocular defocus curve corroborate were in appropriate good visual acuity even at the intermediate distances, by a gentle slope less than log MAR 0.2 at −1.5 D, with regard to the best distance visual acuity at the 0 D defocus.Conclusions:Trifocal AT LISA 939MP IOLs provided appropriate distances, near and intermediate of the visual results. Prediction of the refractive results and optical performances were good.

AimsTo report on 4-year postoperative visual performance with the toric implantable collamer lens (TICL) for stable keratoconus after sequential procedure (corneal collagen crosslinking plus TICL implantation).MethodsForty eyes of 24 patients with stable keratoconus with myopia between 0.00 and −18.00 dioptres (D) and astigmatism between 1.25 and 8.00 D were evaluated in this prospective interventional study (https://clinicaltrials.gov/ct2/show/NCT02833649). We evaluated refraction, visual outcomes, astigmatic changes analysed by Alpins vector, contrast sensitivity, aberrometry, modulation transfer functions (MTFs), defocus curve, and operative and postoperative complications.ResultsAt 4-year follow-up, 45% had 20/20 vision or better and 100% had 20/40 or better uncorrected visual acuity (UCVA). Vector analysis of refractive astigmatism shows that the surgically induced astigmatism (SIA) (3.20±1.46 D) was not significantly different from the target induced astigmatism (TIA) (3.14±1.42 D) (p=0.620). At 4 years postoperatively, none of the eyes showed a decrease in UCVA, in contrast to 24 eyes in which UCVA was increased by ≥1 lines, with contrast sensitivity and improvement in total aberrations and MTF value at 5 per degree (*p=0.004) after TICL implantation. The cumulative 4-year corneal endothelial cell loss was ≤5%. No patients reported dissatisfaction. At the end of follow-up, the vault was 658±54.33m (range, 500–711) and the intraocular pressure was 11.7±2.08 mm Hg. Occurrences of glare and night-driving troubles diminished after TICL surgery.ConclusionThe results from this standardised clinical investigation support TICL implantation from clinical and optical viewpoints in patients with stable keratoconus.Trial registration numberNCT02833649, Pre-results