Innovative Use Of Dsaek Lenticule In Crosslinking Thin Corneas: Our Experience

To study the safety and efficacy of a novel new protocol for collagen cross-linking in thin corneas using a DSAEK (Descemets stripping automated endothelial keratoplasty) lenticule. To evaluate the change in visual, refractive and tomographic parameters in patients with progressive keratoconus in subjects treated using this protocol.

Tertiary eye care hospital in North India

Prospective interventional study. 20 eyes of 14 patients with progressive keratoconus underwent corneal collagen cross-linking (CXL). Corneas with a thickness of less than 400 microns were included. A spatula was used to debride the central 9.0 mm of epithelium. A DSAEK Lenticule from therapeutic grade corneal tissue was prepared using a microkeratome and trephined to a diameter of 8mm. The lenticule was placed and CXL was performed (18mw/ sq cm for 5 minutes). Changes in corrected distance visual acuity(CDVA), spherical equivalent (SE), flat keratometry, steep keratometry, thinnest pachymetry, specular microscopy, and demarcation line were studied at 3 and 6 months.

Improvement in the mean Corrected distance visual acuity (CDVA) and Spherical equivalent were statistically significant (p = 0.03 and p = 0.02) respectively. The flat keratometry changed from (51.44 + 1.87) to (49. 76 + 1.44) which was statistically significant (p=0.048). The steep keratometry changed from (55.65 + 1.77) to (52.35 + 1.65) and this was statistically significant (p = 0.03). Demarcation line was noted in 16 eyes. There was no significant change in the endothelial cell count before and after the procedure (p = 0.88)

Crosslinking in thin corneas is an evolving science. The use of a DSAEK lenticule procured from therapeutic grade tissue is a safe and effective alternative to known techniques using hypotonic riboflavin, transepithelial CXL and tailored stromal expansion using a SMILE lenticule. Further studies are required to achieve optimal outcomes.