Ten-Year Outcomes Of Femtosecond Laser–Assisted Intrastromal Allogeneic Corneal Lenticule Implantation In Keratoconus

To evaluate the 10-year safety, visual outcomes, and biomechanical behavior of femtosecond laser–assisted intrastromal allogeneic corneal lenticule implantation in keratoconus

Vision Health Research Center

This retrospective case series included four eyes of four patients with stable keratoconus who underwent intrastromal allogeneic corneal lenticule implantation between 2014 and 2015. Comprehensive ophthalmic assessments, including visual acuity, refraction, corneal tomography, endothelial cell density, and corneal biomechanical analysis using Corvis ST, were performed preoperatively and at multiple postoperative intervals up to 10 years.

Three eyes with stage Ⅱ–Ⅲ keratoconus (Amslel-Krumeich classification), demonstrated improves or stable corrected distance visual acuity, reduced astigmatism, and stable keratometric indices. Tomographic parameters (BAD-D, Progression Index Average) improved, and central corneal thickness remained stable. Endothelial cell density and morphology were preserved. Biomechanical parameters (DA Ratio, SP-A1, and SSI) indicated stable or enhanced corneal stiffness. The stage Ⅳ case showed progressive thinning and ectasia without visual or tomographic improvement. No graft-related complications, neovascularization, or lenticule displacement occurred.

Femtosecond laser–assisted intrastromal allogeneic corneal lenticule implantation provides long-term structural and biomechanical stability in mild to moderate keratoconus. Its effectiveness in advanced disease appears limited. These findings represent the first 10-year outcomes of this technique and support its potential as a durable, tissue-preserving therapeutic option in carefully selected patients.