Smile Lenticule To Seal Corneal Perforation- A Novel Technique

to showcase the novel technique of using a smile lenticule for sealing a corneal laceration

a 25 year old male with h/o injury with iron foreign body presented to our clinic .on examination he had a shallow anterior chamber and siedels positive. anterior segment OCT  showed a full thickness laceration which had to be sutured after removal of foreign body.

under peribulbar block, the iron foreign body was gently removed making sure not to drop it into the anterior chamber. the gape was sutured using 10-0 nylon sutures. as there was a minimal leak even after suturing a small area of cyanoacrylate glue was applied to seal the wound and a bandage contact lens was placed.

The immediate post-operative period was good with a quiet anterior chamber and no leak. however, after 3 months when complete suture removal was done a wound leak and gape was noted on ASOCT. this time we decided to use a SMILE  lenticule to seal the gap to avoid astigmatism induced by sutures and for a better corneal surface.

using allogenic tissue along with fibrin glue, good tissue integrity was achieved. The disadvantage of irregular astigmatism and patient discomfort due to suture was overcome with glue. also as the smile-derived corneal lenticule is an acellular tissue there exists a lesser risk of rejection, requiring less stringent steroids therapy

corneal micro-perforations secondary to lamellar or full-thickness tears with tissue defect require emergency management to preserve globe integrity and prevent complications and thus visual loss. the aim of treatment is to promote epithelization.,inhibit stromal melting and stromal fibroplasia stimulation. sometimes closure of small wounds with tissue adhesives might be challenging and may require a patch graft which is associated with the disadvantages of limited availability, rejection and long-term steroid usage. Smile lenticule could be used as an alternative tissue additive method to seal perforations with reported optimal outcomes.