Femtosecond Laser-Assisted Keyhole Endokeratophakia: Correction of Hyperopia by Implantation of an Allogeneic Lenticule Obtained by SMILE From a Myopic Donor

Pradhan, Kishore R; Reinstein, Dan Z.; Carp, Glenn I; Archer, Timothy J; Gobbé, Marine; Gurung, Reeta

doi:10.3928/1081597x-20131021-07

Cited by 152 publications

(123 citation statements)

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“…In a case study reported by Pradhan et al,4 a 10 D lenticule was implanted to achieve correction of aphakia but had a high residual refraction of +5 D. There are possible explanations for this result. First, the technique of Pradhan et al of pocket creation was different from the technique used in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The removal of the intrastromal lenticule allows the possibility of reimplantation at a future date 3. The implantation of a lenticule in humans was first reported by Pradhan et al,4 who implanted an allogeneic lenticule obtained by SMILE from a myopic donor for correction of high hypermetropia in a young individual. It may also be possible to implant the extracted lenticule into an unrelated individual to treat conditions like aphakia, hypermetropia, keratoconus, and presbyopia 4.…”

mentioning

confidence: 99%

“…The implantation of a lenticule in humans was first reported by Pradhan et al,4 who implanted an allogeneic lenticule obtained by SMILE from a myopic donor for correction of high hypermetropia in a young individual. It may also be possible to implant the extracted lenticule into an unrelated individual to treat conditions like aphakia, hypermetropia, keratoconus, and presbyopia 4. To achieve this, the integrity of the extracted stromal lenticule must be maintained after long-term storage.…”

mentioning

confidence: 99%

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Cryopreservation of Extracted Corneal Lenticules after Small Incision Lenticule Extraction for Potential Use in Human Subjects

Ganesh

Brar²,

Rao³

2014

Cornea

141

109

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Purpose:To describe the technique of cryopreservation of corneal lenticules extracted after small incision refractive lenticule extraction (ReLEx SMILE) and initial results of femtosecond laser intrastromal lenticular implantation for hyperopia.Methods:Lenticules were collected from patients undergoing ReLEx SMILE for the correction of myopia and subjected to a tissue processing technique and cryopreservation. These lenticules were subsequently used to treat 8 hyperopic eyes and 1 aphakic eye. A femtosecond laser was used to create a pocket into each patient's cornea, followed by implantation of a cryopreserved lenticule. The patients were monitored through follow-up examinations for a mean 155.4 days (38–310 days).Results:The mean interval from storage of lenticules to removal from liquid nitrogen was 96 days (range, 19–178 days). Mean spherical equivalent of hyperopic eyes treated was +4.50 ± 1.1 diopter (D). Mean keratometry and pachymetry changed from preoperative 43.9 D and 531.6 μm to 47.4 D and 605.2 μm, respectively, postoperatively. Mean residual spherical equivalent for hyperopic eyes was +0.6 D and +4.1 D for the aphakic eye. None of the eyes showed evidence of rejection or loss of best-corrected visual acuity at the end of the follow-up period.Conclusions:The cryopreservation technique seems to be a safe method of long-term storage of refractive lenticules extracted after ReLEx SMILE for use in allogeneic human subjects. It may potentially be a safe and effective alternative to excimer laser ablation for hyperopia because of the low risks of regression, haze, flap-related complications, postoperative dry eye, and higher-order aberrations.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: CTRI/2014/01/004331.

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Section: Discussionmentioning

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confidence: 99%

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Cryopreservation of Extracted Corneal Lenticules after Small Incision Lenticule Extraction for Potential Use in Human Subjects

Ganesh

Brar²,

Rao³

2014

Cornea

141

109

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“…94 A case of successful allogeneic lenticule transplantation in a severely hyperopic patient has also been reported. 95 Despite successful incorporation of the lenticule, a posterior corneal protuberance developed, contributing to a severe reduction in the refractive corrective ability of the implanted lenticule. Lenticule reimplantation, autologous or allogeneic, could prove useful in the treatment of ectatic conditions and spherical/cylindrical errors or for later restoration of corneal thickness in preparation for ablative procedures in presbyopic patients.…”

Section: Future Possibilitiesmentioning

confidence: 99%

Small-incision lenticule extraction

Moshirfar¹,

McCaughey²,

Reinstein³

et al. 2015

Journal of Cataract and Refractive Surgery

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“…Second, the lenticule has been used to change the refraction in another individual by implanting a myopic lenticule in the stromal pocket of a hyperopic patient. 50 Such a procedure would, at least in Europe, require permission from national authorities, as this would be considered a corneal transplantation.…”

Section: Unique Perspectives For Intrastromal Lenticule Extractionmentioning

confidence: 99%

New Developments in the Lenticule Extraction Procedure

Hjortdal¹,

Ivarsen²

2014

European Ophthalmic Review

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31Over the last few years, surgical extraction of a refractive lenticule, or ReLEx ® , has evolved as a new treatment in the field of keratorefractive surgery. Currently, the VisuMax ® femtosecond (FS) laser (Carl Zeiss Meditec, Jena, Germany) is the only platform to offer this treatment.The 500 kHz VisuMax laser generates very fast pulses (10 -15 s range) in the near-infrared spectrum. Depending on the specific laser settings, each pulse conveys approximately 150 nJ, which causes localised photodisruption at the focal point. The generated plasma expands, creating a cavitation bubble, and, as individual cavitation bubbles fuse, the stroma is cut with a minimum of collateral damage. The VisuMax FS laser uses a high numerical aperture and a concave contact glass to focus the laser pulses with very high precision. Thus, laser spots of approximately 1 μm diameter are placed with a defined distance of 2-5 μm in a spiral pattern. To ensure centration on the visual axis, the patient fixates on a blinking light and suction is applied at the limbus to maintain stability of the eye. Initially, the posterior refractive surface of the lenticule is cut, followed by creation of the plano anterior surface, which is slightly enlarged in diameter to facilitate surgical manipulation.This review article reviews the current state of the technique, updated clinical results, 1 experimental studies and, finally, presents some of the challenges that need to be addressed by new technologies.Depending on the method used to access the lenticule, ReLEx can be split into FLEx, in which a laser-assisted in situ keratomileusis ( In contrast to LASIK, ReLEx is a one-laser approach, where the critical laser treatment is performed on the intact cornea rather than on exposed corneal stroma. Consequently, the potential variability associated with the excimer laser photoablation is avoided.In addition, the minimally invasive SMILE treatment has several theoretical advantages over flap-based treatments, including little trauma to the corneal surface, less corneal denervation and better biomechanical strength due to an almost intact anterior stroma. Since AbstractFor the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism.Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualise...

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Femtosecond Laser-Assisted Keyhole Endokeratophakia: Correction of Hyperopia by Implantation of an Allogeneic Lenticule Obtained by SMILE From a Myopic Donor

Cited by 152 publications

References 12 publications

Cryopreservation of Extracted Corneal Lenticules after Small Incision Lenticule Extraction for Potential Use in Human Subjects

Cryopreservation of Extracted Corneal Lenticules after Small Incision Lenticule Extraction for Potential Use in Human Subjects

Small-incision lenticule extraction

New Developments in the Lenticule Extraction Procedure

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