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Corneal lenticule implantation (intra-keratoplasty) and corneal cross linking CXL-Intrakeratoplasty (iK-CXL) in patients with advanced keratoconus

Poster Details

First Author: I.Pallikaris GREECE

Co Author(s):    E. ÇoÅŸkunseven   A. Ozdamar           

Abstract Details


To evaluate outcomes of combined corneal lenticule implantation (intra-keratoplasty) and corneal cross linking in patients with advanced keratoconus


Dunya Eye Hospital Istanbul Turkey Refractive corneal lenticules (thickness of 159 and 141 microns) using Visumax Femtosecond Laser (Zeiss Meditech, Germany) for Relax SMILE myopic procedure were explanted and cryo-preserved.


These corneal lenticules were re-implanted in two patients (22 and 27 years-old) with advanced (corneal thickness less than 350 microns) progressive keratoconus (scheduled for deep anterior lamellar keratoplasty) after corneal lamellar pockets [using the Intralase Femtosecond Laser ( Intralase 150 khz, Abbott Medical optics USA)] were created at the 50% of the calculated corneal thickness (170μm). Corneal cross linking was applied at the first lenticule before implantation at the recipient’s corneal stromal while in the second patient CXL was applied after the corneal lenticule implantation, in the entire cornea.


Logarithm of the minimum angle of resolution (logMAR) mean uncorrected visual acuity and the mean best spectacle-corrected visual acuity improved significantly from 0,05 and 0,1 preoperatively to 0,1 and 0,2, respectively, at the last follow-up. Mean steep and mean flat keratometry readings changed from 61,10 diopters (D) and 56,35 D preoperatively to 65,45 and 61,1D, respectively, at the last follow-up. The mean endothelial cell density was 2770 cells per square millimeter preoperatively and did not change at the last follow up. The cornea thickness increased at the last visit equally to the lenticule thickness, respectively from 350µ to 520µ and 333µ to 500µ. The major difference between the two patients was the rehabilitation time, respectively the total CXL patient needed 5 days and the lenticule CXL patient needed 1 day.


Combined corneal lenticule implantation (intra-keratoplasty) and CXL (iK-CXL) seems to have promising results in patients with advanced stages of keratoconus.

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