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International Ophthalmology

, Volume 39, Issue 11, pp 2575–2581 | Cite as

Small-incision lenticule addition in ex vivo model of ectatic human corneas

  • Emilio PedrottiEmail author
  • Tiziano Cozzini
  • Adriano Fasolo
  • Erika Bonacci
  • Jacopo Bonetto
  • Tommaso Merz
  • Pietro Talli
  • Giorgio Marchini
Original Paper
  • 56 Downloads

Abstract

Purpose

To investigate the feasibility of intrastromal lenticule insertion to restore corneal shape in a model of ectatic human cornea.

Methods

For this experimental ex vivo study on 34 human corneas unsuitable for transplantation, 17 corneas were thinned by decentralized posterior excimer laser ablation to 200 μm thickness and 6.5 mm diameter and then inflated up to 100 mm Hg to expose the ectasias (recipient corneas). Pachimetry and topography were obtained. Stromal lenticules of the same diameter and thickness as the ectasias were shaped with a femtosecond laser from the remaining 17 donor corneas. An intrastromal pocket was created with femtosecond laser within the ectatic recipient corneas and the donor lenticule was inserted inside it. Changes in corneal architecture and profile were evaluated by means of corneal topography and anterior segment optical coherence tomography.

Results

All stromal lenticules were successfully implanted. Tomography confirmed regularity of the lenticule profile within the stromal pocket. Corneal thickness was significantly increased after the procedure (P < 0.0001). Maximal posterior elevation from the best-fitted toric ellipsoid was significantly reduced (P < 0.0001). Significant flattening of posterior K1 and K2 was also obtained (P = 0.041 and P = 0.004, respectively). Anterior and posterior astigmatism, anterior and posterior asphericity, and spherical aberration did not differ significantly after the procedure.

Conclusions

Femtosecond laser-assisted stromal lenticule addition is feasible for restoring corneal thickness to an ectatic area and for regularizing posterior corneal elevation. The technique opens new perspectives for the treatment of corneal ectasias.

Keywords

Additive keratoplasty Ex vivo model Ectasia Femtosecond laser-assisted surgery 

Notes

Funding

This study was funded by a Grant from Bausch & Lomb Incorporated.

References

  1. 1.
    Mohammadpour M, Heidaria Z, Hashemic H (2018) Updates on managements for keratoconus. Curr Ophthalmol 30:110–124CrossRefGoogle Scholar
  2. 2.
    Mastropasqua L, Nubile M (2017) Corneal thickening and central flattening induced by femtosecond laser hyperopic-shaped intrastromal lenticule implantation. Int Ophthalmol 37:893–904CrossRefGoogle Scholar
  3. 3.
    Angunawela RI, Riau AK, Chaurasia SS, Tan DT, Mehta JS (2012) Refractive lenticule re- implantation after myopic ReLEx: a feasibility study of stromal restoration after refractive surgery in a rabbit model. Invest Ophthalmol Vis Sci 53:4975–4985CrossRefGoogle Scholar
  4. 4.
    Liu H, Zhu W, Jiang AC, Precher AJ, Zhou X (2012) Femtosecond laser lenticule transplantation in rabbit cornea: experimental study. J Refract Surg 28:907–911CrossRefGoogle Scholar
  5. 5.
    Riau AK, Angunawela RI, Chaurasia SS, Lee WS, Tan DT, Mehta JS (2013) Reversible femtosecond laser-assisted myopia correction: a non-human primate study of lenticule re-implantation after refractive lenticule extraction. PLoS ONE 8:e67058CrossRefGoogle Scholar
  6. 6.
    Mastropasqua L, Nubile M, Salgari N, Mastropasqua R (2018) Femtosecond laser-assisted stromal lenticule addition keratoplasty for the treatment of advanced keratoconus: a preliminary study. J Refract Surg 34:36–44CrossRefGoogle Scholar
  7. 7.
    Knox Cartwright NE, Tyrer JR, Jaycock PD, Marshall J (2012) Effects of variation in depth and side cut angulations in LASIK and thin-flap LASIK using a femtosecond laser: a biomechanical study. J Refract Surg 28:419–425CrossRefGoogle Scholar
  8. 8.
    Alió Del Barrio JL, El Zarif M, Azaar A, Makdissy N, Khalil C, Harb W, El Achkar I, Jawad ZA, de Miguel MP, Alió JL (2018) Corneal stroma enhancement with decellularized stromal laminas with or without stem cell recellularization for advanced keratoconus. Am J Ophthalmol 186:47–58CrossRefGoogle Scholar
  9. 9.
    Patel AK, Scorcia V, Kadyan A, Lapenna L, Ponzin D, Busin M (2012) Microkeratome-assisted superficial anterior lamellar keratoplasty for anterior stromal corneal opacities after penetrating keratoplasty. Cornea 31:101–105CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Emilio Pedrotti
    • 1
    Email author
  • Tiziano Cozzini
    • 1
  • Adriano Fasolo
    • 1
    • 2
  • Erika Bonacci
    • 1
  • Jacopo Bonetto
    • 1
  • Tommaso Merz
    • 1
  • Pietro Talli
    • 1
  • Giorgio Marchini
    • 1
  1. 1.Eye Clinic, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of Verona, Policlinico G.B. RossiVeronaItaly
  2. 2.The Veneto Eye Bank FoundationVeniceItaly

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