Use Of Discarded Hyperopic Smile Lenticule To Correct Myopic Refractive Error For A Patient Had Previous Refractive Surgery(Prk) With Thin Cornea And Low Acd By Small Incision Lenticule Implantation

to emphasize the possibility of using discarded hyperopic smile corneal stromal lenticule use to correct myopic refractive error in case  were unoperable by laser vision correction or Phakic intraocular lens implantation.

the case performed iin Noor Ophthalmic Center, Najaf,Iraq, at October 20th ,2025

22 years old male patient

RE DUCVA 6/15 PH NC 

LE DUCVA CF 2 meters , DCVA  6/12 (-6.0/-1.0 DC @005)

corneal parameters CCT left eye 491 Um 

ACD 2.57 mm

hyperopic smile lenticule discarded from apatient after femtosmile surgery reused to correct the myopia  by insertion through a stromal pocket 8.8 mm in diameter and at depth of 120Um 

the lenticule diameter was 8.2 mm and 105 Um in peripheral thickness and 25 Um centrally

myopic refractive error correction can be done primarely by laser platforms which cover a wide spectrum of myopic refractive error correction from small degree up to -10.0 DS if the cornea permits, the platforms are the excimer laser and femtosecond laser, other method of correction by phakic intraocular lens implantation like pc IOL as visian ICL, or iris fixed AC IOL, in the case of unoperable cornea cause of limited central corneal thickness and limited anterioir chamber depth its not possible to implant PIOL. The reuse of discarded hyperopic lenticule present a chance  of correction this group of patient by tissue addition of this hyperopic smile lenticule into a pocket inside corneal stroma of the patient, this hyperopic lenticule tissue addition will reshape the corneal surface and compensate the myopic refractive error.the ucva was CF 2 meters ih his left eye, after lenticule implantation the ucva was improved to 6/15 during the first 7 days . the subsequent follow up visits show little improvemt in ucva and the ucva was settled at 6/15 after the end of the three  months, each visit the ucva was checked in addition  IOP and  anterior and posterior segment examination , with each visit every positive finding was recorded,at the end of the first three months no intrastromal interphase haze was noted, lenticule graft kept in place with no displacement, no extrusion happenend, no keratitis recorded during the follow up visits no epithelial erosion or ulceration occured  

the reuse of discarded stromal lenticule tissue from femtosecond laser for hyperopic refractive correction can present good opportunity to treat previously unoperrable patient with limited CCT or unfit ACD for PIOL,the future correction can by ajdusted more by even excimer ablasion to deal with a customized lenticule to cover astigmatic correction for those group of patients by customized preprepared lenticule with adjustment of axis of the reciepent cornea and the axis of the donar entricule.