Exploring The Role Of Biomechanics Integrated Lenticular Extraction (Bilex) And Its Impact On Post-Operative Outcomes

To evaluate the impact of corneal biomechanics on intra-operative opaque bubble layer (OBL) formation and ease of dissection on postoperative outcomes.

Tertiary eye care centre, India

Preoperative corneal topography, biomechanics, corneal elasticity using Young’s modulus and collagen orientation were performed on 150 eyes undergoing lenticular extraction. Intraoperative OBL formation was graded along with the ease of dissection. Quality of vision was assessed using the QoV questionnaire. This data was compared and analyzed for postoperative complete recovery of visual quality and quantity along with patient satisfaction.

All patients achieved 20/20 visual acuity as per the Snellen’s chart on POD-1. In 70 eyes with higher corneal elasticity and thicker Bowman's membrane, grade 2-3 OBL was noted intraoperatively with a tough grade of dissection. These eyes had a slower recovery in QoV scores. The remaining eyes (n=80) with normal biomechanics, normal corneal elasticity, normal collagen orientation, and normal thickness Bowman’s membrane had grade 1 OBL intraoperatively and had a loose grade of dissection. These eyes had faster recovery in QOV scores compared to the other group. However, at the end of 1 month, both groups had comparable QOV scores.

Biomechanics, OBL formation, and intraoperative dissection are all integrated and can impact the speed of visual recovery. In the future, this data can be used to modulate laser energies, spot size, and track distance.