Double smile lenticular graft in impending corneal perforation
First Author: A.Kotb EGYPT
Co Author(s): S. El-Sayed
To study application of double stromal lenticules extracted by femtolaser small incision lenticule extraction (SMILE) surgery as a surgical adjuvant for sealing impending corneal perforation.
Confirmation of impending corneal perforation carried out by Seidel test using sterile fluorescein staining. Best spectacle-corrected visual acuity (BSCVA) was assessed preoperatively. Corneal perforation size was recorded preoperatively by slit lamp scale (ranged from 1.5 to 3.5 mm) and confirmed intraoperatively.
Double Corneal stromal lenticules obtained through SMILE surgery with central thickness 65 µm for each lenticule were fixed over corneal impending perforation sites using 10-0 nylon interrupted stitches. Twenty patients were monitored for a minimum of 1 year and were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications were recorded throughout the follow up period.
Impending Corneal perforations had successfully been sealed in all 16 patients from 20 patients. (1 case) exhibited continuous leak with progressive infection and ended by PKP, (1 case) exhibited leak due to loose stitch and resutured. Another 2 cases showed persistent hypotony and required AMG augmentation. (2 cases) exhibited sliding grafts over each other with no intervention needed.
These preliminary findings suggest that the use of double corneal lenticules may be a safe and effective surgical adjuvant for corneal perforation closure, with potential clinical application as relatively simple and inexpensive temporary measures to improve corneal condition for further definitive interventions.