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Femtosecond laser-assisted keyhole endokeratophakia

Session Details

Session Title: Corneal Femtosecond

Session Date/Time: Monday 07/10/2013 | 14:30-16:30

Paper Time: 15:28

Venue: Elicium 1 (First Floor)

First Author: : K.Pradhan NEPAL

Co Author(s): :    D. Reinstein   G. Carp   T. Archer   M. Gobbe   R. Gurung  

Abstract Details


To describe a new procedure called endokeratophakia in which a small incision lenticule extraction (SMILE) lenticule from a myopic patient is implanted into a recipient eye through a small incision to correct hyperopia.


Tilganga Institute of Ophthalmology, Kathmandu, Nepal


A 23 year old aphakic female following cataract surgery to remove a congenital cataract in childhood presented with hyperopia of +12.00 -1.50 x 155, CDVA of counting fingers and exotropia. First, a routine SMILE procedure using the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) was performed on a second patient with high myopia and the extracted lenticule (power -10.50 DS, optical zone 5.75 mm, maximum central lenticule thickness 127 ?m) was stored in a donor cornea culture medium. The endokeratophakia procedure was then performed for the hyperopic patient. First, the femtosecond interface creation part of a SMILE procedure was performed. The upper interface was separated, but the lower interface was left unseparated. The donor lenticule was inserted into the space provided by the upper interface through the small incision using a Kelman forceps holding the donor lenticule lengthwise along a diameter. The donor lenticule was distended until flat and centered.


Six months postoperatively, the manifest refraction was +7.50 -3.00 x 150, a reduction in spherical equivalent of 5.25 D. The mean keratometry had increased by 2.91 D from 41.39 D to 44.30 D. The posterior surface elevation had also changed significantly with a central bulge into the anterior chamber. Central pachymetry by Pentacam had increased by 121 ?m from 547 ?m to 668 ?m. The RTVue OCT (Optovue Inc., Fremont, CA) scan measured the central lenticule thickness as 130 ?m and the central epithelial thickness as 43 ?m. The IOP was 13.8 mmHg and the endothelial cell count was 2750 cells/mm2. The cornea remained clear over the 6 month postoperative period.


Endokeratophakia appears to be a viable procedure for the correction of hyperopia on the cornea by implantation of an extracted myopic SMILE lenticule from a donor patient. There were no adverse side effects to the implantation of donor tissue. However, posterior surface changes and epithelial remodelling resulted in only 50% of the intended correction.

Financial Interest:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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