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Intrastromal keratoplasty with femtosecond accompaniment and excimer modeling: 5 years of observation
First Author: T. Shilova RUSSIA
To evaluate the effectiveness of the technique of treatment late-stage keratoconus by implanting lenticular material with excimer modeling into the corneal pocket formed by a femtosecond laser and an additional CLX. To assessed the stability of results over 5 years.
SMILE EYES Moscow, Russia
Study included 50 eyes with keratoconus III -IV with cornea thickness less than 360 microns. ReLEx SMILE technique created the lenticule with optical zone 6.8-7 mm, thickness part 170 ﾖ 220 microns. Central area of lenticule was ablated in the ART mode by VISX Star S4 IR with a diameter of 5 mm and optical power from up to -15 diopters to get hypermetropic shape. The central zone was not less than 30 microns. In the recipient's cornea we formed a bed 7 -7,2 mm and implanted the lenticule throw 2 mm. No need for suturing. After CLX was implemented.
Every 3 months in the first year and every six months in the following years, examinations were performed, including pachymetry, Pentacam, corneal OCT, and CORVIS. Corneal thickness increased by 42-74%, BCVA and UCVA increased in all cases. We observed an improvement in corneal biomechanical strength according to CORVIS indices, and the absence of immune responses. Subsequent selection of scleral lenses or implantation of phakic IOLs significantly improved the quality of vision in these patients.
The method of treatment late-stage keratoconus by implanting lenticule material with excimer laser modeling has no risk of perforation when compared with DALK, maintaining transparency and seamless. This way we preserve the patient's own cornea. It can be used with native material after ReLEX SMILE with reclamation function. Thanks to excimer grinding both uncorrected and corrected visual acuity are increase, the cornea gets a more correct shape. After intrastromal keratoplasty using this method additional correction is possible in various ways (phakic IOL or conventional IOL with phacoemulsification of the eye's own lens).
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