Small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism

Abstract

Purpose To quantitatively evaluate outcomes after small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism. Methods It’s a retrospective cohort study. Twenty-four eyes of 15 patients with more than 0.75 diopters (D) of astigmatism in hyperopic eyes were enrolled in this study. The hyperopic eye with astigmatism was first treated with SMILE to correct astigmatism; then a lenticule was extracted from a donor myopic eye and subsequently implanted into the hyperopic eye with astigmatism. Patients were examined preoperatively and 1 day, 1 week, 1,3 months and 1 year after surgery. The main outcome measures were the uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected near visual acuity (UNVA), spherical equivalent (SE), corneal topography, anterior segment optical coherence topography (OCT) and ocular response analyzer (ORA) parameters: corneal hysteresis (CH) and corneal resistance factor (CRF). Repeated–measures analyses of variance (ANOVA) and post hoc tests were used to analyze data of different follow-up visits. Results The mean preoperative cylinder was 1.95±1.04(D). The UDVA (from 0.37±0.23 to 0.09±0.09), UNVA (from 0.49±0.21 to 0.08±0.06), SE (from +7.42±3.12 to -0.75±0.79) and astigmatism (+1.95±1.04 to -0.65±0.63) postoperatively were obviously better than those before surgery. Five eyes (26.3%) gained one line of CDVA, and 3 eyes (15.8%) gained two lines of CDVA one year after surgery compared with preoperative levels. The average corneal curvature was changed from (43.19±4.37) D to (49.19±3.87) D one year after surgery. The anterior segment OCT images of corneas with lenticule inlays at each follow-up visit showed that the implanted lenticule was shaped like a crescent in the corneal stroma. The CH and CRF didn’t change significantly after surgery (p = 0.189 and p = 0.107respectively). Conclusions SMILE combined with intrastromal lenticule inlay can be used to correct high hyperopia with astigmatism with good safety, efficacy and reproducibility.

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)

“…In contrast, after FS-LIKE, the anterior portion of the cornea was weakened, and little tensile strength was observed. The lenticule experienced little resistance and no backward change in elevation was noted [ 10 ]. The results of the current study are consistent with those of Wu and colleagues, who described the outcomes of hyperopia correction using FS-LIKE, and found no anteroposterior forces exerted by lenticule implantation in FS-LIKE [ 11 ].…”

Late recurrence of corneal dystrophy treated with phototherapeutic keratectomy combined with epikeratophakia using double lenticules

“…3 Zhang et al reported that corneal refractive power and thickness remained stable over the 1 month and 1 year of follow-up after implantation of donor lenticules in patients with hyperopia, which is consistent with this case. 10 Compared with corneal transplantation, PTK is a noninvasive procedure because of the absence of sutures, which makes postoperative rejection reaction less likely. 9 EP is used to correct high refractive error or treat corneal pathology by grafting allograft lenticules of different diopters onto the surface of the epithelium-removed cornea without damaging the Bowman layer and corneal stroma.…”

“…3 Zhang et al reported that corneal refractive power and thickness remained stable over the 1 month and 1 year of follow-up after implantation of donor lenticules in patients with hyperopia, which is consistent with this case. 10…”

Review of Presbyopia Treatment with Corneal Inlays and New Developments

“…38,39 Lenticules from SMILE have already been implanted in patients with hyperopia, keratoconus, and astigmatism. 40,41 https://doi.org/10.2147/OPTH.S375577…”

“…SMILE, approved in 2016 for the surgical management of refractive errors, removes a corneal lenticule that can be preserved and transplanted into a recipient eye (either the donor’s other eye or another patient) to correct refractive errors. 41 Jacob et al created a pocket 120μm deep in the corneal stroma using a femtosecond laser with a diameter of 7.9mm. A central pocket was then dissected, and the PEARL inlay was implanted.…”