Over 2 Years Follow Up Of 100 Keratoconus Patients Treated With Xenia Implant, The Old Superficial Versus New Deep Cornea Technique

To evaluate the safety and efficacy of a deep versus superfecial  XENIA  implanted decellularized porcine corneal lenticule in treating patients with advanced keratoconus

Keratoconus is a common corneal ectasia characterized by progressive thinning, steepening, and bulging of the central and paracentral cornea, often causing visual loss  The early stages of the disease can be managed with glasses, rigid contact lenses or (ICRS) .(CXL)is an effective treatment modality to prevent KC progression  Although the mainstay of treatment for advanced KC has  been PK or DALK The Xenia implant is lenticule designed for the treatment of advanced KC

25 previously cross-lined eyes out of 100 KC patients were included in this case series study. A 9-mm posterior-stromal pocket (100 μm from the corneal endothelium) was manually created using a calibrated and guarded knife or Femtosecond assissted laser . A decellularized, cross-linked porcine corneal lenticule (55 +/-5 microns thickness and 7.5-8.0 mm diameter) was inserted into the pocket. The visual, pachymetric, topographic, tomographic, and corneal higher-order aberrations (HOAs) outcomes were evaluated preoperatively and at least 6 months post-operatively.

At 24 months postoperatively, the mean anterior keratometries, flat K, steep K, average K values significantly decreased (p < 0.05, for all). The mean anterior corneal elevation and posterior corneal elevation values significantly decreased from 31.4 ± 18.1µm and 47.2 ± 13.13 µm, respectively to 5 ± 2.67 µm and 8.6 ± 11.88 µm, respectively (p = 0.0149 and 0.0015, respectively). Although not reaching statistically significance, the mean central corneal thickness values increased from 429 ± 22.19 µm preoperatively to 462.8 ± 21.89 µm postoperatively (p = 0.1496

mean total HO decreased to 1.892 (0.0731) and the mean coma decreased to 1.129 (0.0152). The mean SA decreased to 0.393 (0.0238). The change HO, coma, SA was statistically significant

The modified technique of posterior corneal stromal implantation with pocket creation via manual delamination or Femtoscond laser assisted, in combination with anterior corneal collagen cross-linking is safe and results in significant improvements. This new novel technique for implants may become the standard surgical treatment for keratoconus that comprehensively addresses the disease and its visual consequences.