Application of the SMILE-Derived Glued Lenticule Patch Graft in Microperforations and Partial-Thickness Corneal Defects

Bhandari, Vipul; Ganesh, Sri; Brar, Sheetal; Pandey, Rahul

doi:10.1097/ico.0000000000000741

Cited by 54 publications

(27 citation statements)

References 18 publications

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“…In a separate study, Ganesh and colleagues used similarly extracted stromal lenticules to treat a series of cases of corneal micro-perforation, corneal defect and traumatic corneal tear, by using the lenticule as a bandage patch by attaching it to the recipient cornea using fibrin glue. 28 The procedure was safe and maintained corneal transparency and integrity. Extending the application of this concept, Wu and colleagues used SMILE lenticules with thickness over 100 µm to seal corneal perforations by suturing the lenticules over the perforation sites.…”

Section: Human Donor Stromal Lenticulesmentioning

confidence: 88%

“…Although ambitious, these goals are within reach given the current pace in the development of corneal regenerative technologies and the parallel developments in clinical evaluation and regulatory approvals of advanced therapeutic modalities. Integration with host stroma [28][29][30] Acellular porcine corneal stroma Abundant, low cost, thick stromal tissue Integration with rabbit stroma, host cells in scaffold 35,38 No evidence provided 39,40 Recellularized scaffolds Cells can actively effect stromal repair Human embryonic stem cells Pluripotent, high proliferative potential…”

Section: Discussionmentioning

confidence: 99%

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Corneal Stromal Regeneration: Current Status and Future Therapeutic Potential

Lagali

2019

Current Eye Research

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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 recellularized, 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. ARTICLE HISTORY

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Section: Human Donor Stromal Lenticulesmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Corneal Stromal Regeneration: Current Status and Future Therapeutic Potential

Lagali

2019

Current Eye Research

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“…Furthermore, inflammatory and/or immune-mediated conditions often induce a high risk of complications or graft failure after corneal transplantation 10 . Therefore, efforts have been made to identify a practical, accessible, and low biological risk corneal substitute for treating deep corneal defects and corneal perforations 2 4 17 18 25 26 . Chen et al .…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, Bhandari et al . also reported the efficacy of SMILE-derived lenticule patch grafts for the management of corneal microperforations and lamellar corneal defects 18 . These studies expanded the current strategies for the management of corneal perforation and partial-thickness corneal defects and demonstrated that the use of SMILE-derived lenticules is a safe, effective, easily accessible, and inexpensive alternative for corneal stroma reconstruction.…”

mentioning

confidence: 99%

Construction of a Corneal Stromal Equivalent with SMILE-Derived Lenticules and Fibrin Glue

Yin

Qiu

et al. 2016

Sci Rep

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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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“…Формирование тонких лентикул в свою очередь может привести к фрагментации лентикулы и сложностям мануальной диссекции. Чтобы избежать этого, при подборе параметров нужно соотносить размер оптической зоны, оптически нейтрального слоя и энергетических параметров лазера [13,14].…”

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