Xenia Intrastromal Implant As A Less Invasive Alternative To Dalk For Advanced Keratoconus: A Case Report

To report the clinical outcomes of XENIA intrastromal corneal implant in a patient with progressive keratoconus, demonstrating its effectiveness as a minimally invasive alternative to deep anterior lamellar keratoplasty (DALK). This case illustrates how XENIA implantation can stabilise corneal ectasia, improve best corrected visual acuity (BCVA), and restore functional vision in advanced keratoconus while avoiding the complexities and risks associated with corneal transplantation.

OCL Vision, London, United Kingdom

A 49-year-old female with progressive bilateral keratoconus (left > right) underwent XENIA implant placement in the left eye. Preoperatively, the left eye demonstrated severe central keratoconus with Kmax 69.3D, K1 51.3D, K2 57.6D, central corneal thickness (CCT) 448μm unaided vision of logMAR 0.82 and BCVA logMAR 0.82. The right eye showed mild keratoconus with Kmax 53.0D. A femtosecond laser created intrastromal pocket for XENIA implant insertion. Postoperative evaluations were conducted at 7 days, 3 months, and 6 months, assessing uncorrected and best corrected visual acuity, manifest refraction, pentacam tomography and corneal thickness.

At 7 days post-implantation, left eye UCVA improved to 1.00, pinhole 0.54, with manifest refraction -3.00/-4.50×36 achieving BCVA logMAR 0.54. Kmax decreased to 53.5D (from 69.3D), K1 to 47.1D, K2 to 50.6D, and CCT increased to 499μm. At 3 months, UCVA was LogMAR 0.8, refraction -3.00/-4.50×30 with BCVA 0.4, Kmax 51.5D, K1 46.2D, K2 49.4D, CCT 496μm. At 6 months, results remained stable with UCVA LogMAR 0.8, refraction -3.25/-4.00×30° with BCVA LogMAR 0.3, Kmax 51.7D, K1 46.2D, K2 49.6D and CCT 496μm. The procedure successfully flattened the cone (Kmax reduction 17.6D), improved corneal regularity, increased thickness by 48μm, and significantly improved BCVA.

XENIA intrastromal corneal implant represents a promising, minimally invasive therapeutic option for advanced keratoconus. This case demonstrates substantial improvement in BCVA, significant corneal flattening and stabilisation of ectatic progression without the need for DALK. The procedure offers multiple advantages: outpatient surgery with topical anesthesia, sutureless, rapid visual recovery, increased corneal thickness enabling potential future crosslinking and reversibility if needed. The sustained improvements at 6-month follow-up suggest XENIA can defer or potentially prevent corneal transplantation in suitable candidates, providing patients with improved vision and quality of life while avoiding transplant-related complications.