Search

Purpose: The aim of this study was to evaluate the safety, efficacy, and predictability of lenticule intrastromal keratoplasty (LIKE) for the correction of iatrogenic high hyperopia., Methods: Three patients (4 eyes) were referred to our department because of overcorrection of myopia induced by femtosecond laser-assisted in situ keratomileusis. All eyes exhibited hyperopia (between +4.00 and +8.00 D) and thin corneas ranging from 307 to 378 μm. Because of the regression of the use of laser ablation to correct high hyperopia and thin corneas, we initially adopted LIKE to correct iatrogenic high hyperopia in all 4 eyes. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, and anterior segment optical coherence tomography findings were recorded during each follow-up evaluation., Results: No postoperative complications, such as interface haze and opacification, were observed in the 4 eyes during each follow-up evaluation, with an average follow-up of 9.50 months. All eyes had significantly improved UDVA postoperatively. A total of 3 eyes achieved an UDVA of 20/25 or better while the other 1 eye had an UDVA of 20/40 postoperatively. In addition, 2 of the 4 eyes had a postoperative UDVA equal to or better than preoperative CDVA. No eyes lost any CDVA lines. All 4 eyes were within ±0.50 D of the spherical power (intended target of 0). The central corneal thickness and curvature of the anterior corneal surface in all 4 eyes increased postoperatively. Anterior segment optical coherence tomography revealed that the lenticule was transparent, with no wrinkles or offsets, during each follow-up evaluation., Conclusions: LIKE for the correction of iatrogenic hyperopia has good efficacy and safety. Although an extremely thin cornea after overcorrection may not be suitable for hyperopic laser enhancement, LIKE is a good choice because of its good predictability and ability to restore the normal corneal structure., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The aim of the study was to evaluate and compare the long-term visual outcomes and higher-order aberrations (HOAs) between femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule intrastromal keratoplasty (SMI-LIKE) in the correction of moderate to high hyperopia., Methods: In this study, 16 subjects (20 eyes) underwent FS-LASIK and 7 subjects (10 eyes) underwent SMI-LIKE. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, mean keratometry (Km), anterior asphericity (Q), and HOAs preoperatively and 2 years postoperatively were obtained in both procedures., Results: The efficacy indices of the FS-LASIK group and the SMI-LIKE group were 0.85 ± 0.14 and 0.87 ± 0.17, respectively. The safety indices of the FS-LASIK and SMI-LIKE groups were 0.99 ± 0.15 and 1.08 ± 0.24, respectively. No significant difference in safety index or efficacy index was found between the FS-LASIK and SMI-LIKE groups (all P > 0.05). The correlation coefficient of the attempted versus achieved spherical equivalent postoperatively was 0.69 ( P < 0.01) and 0.89 ( P < 0.01) in the FS-LASIK group and SMI-LIKE groups, respectively. The front Km, negative Q value, negative spherical aberrations (SAs), coma, and total HOAs significantly increased postoperatively in the 2 groups ( P < 0.05). The FS-LASIK group had greater changes in Q value and SA postoperatively than the SMI-LIKE group ( P < 0.01)., Conclusions: SMI-LIKE had similar safety and efficacy to FS-LASIK in the correction of moderate to high hyperopia. However, SMI-LIKE may equip better visual quality postoperatively for its lower Q value and SA changes than FS-LASIK., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Aim: This study aimed to evaluate the visual outcomes and corneal densitometry (CD) after allogenic lenticule intrastromal keratoplasty (AL-LIKE) and autologous lenticule intrastromal keratoplasty (AU-LIKE) for the correction of moderate-to-high hyperopia., Methods: Ten subjects (14 eyes) underwent AL-LIKE and eight (8 eyes) underwent AU-LIKE. Patients were examined preoperatively and 1 day, 1 month, and 6 months postoperatively. The visual outcomes and CD for both surgical methods were evaluated., Results: No postoperative complications were observed with either method. The efficacy index was 0.85±0.18 and 0.90±0.33 in the AL-LIKE and AU-LIKE groups, respectively. The safety indices were 1.07±0.21 and 1.25±0.37 in the AL-LIKE and AU-LIKE groups, respectively. The CD values of the anterior, central, and posterior layers in the AL-LIKE group increased significantly at 1 day postoperatively (all P < 0.05). The CD values of the anterior and central layers remained significantly higher than the preoperative values at 6 months postoperatively (all P < 0.05). The CD values of the anterior layer in the AU-LIKE group increased significantly 1 day postoperatively (all P < 0.05) and decreased to preoperative values (all P > 0.05) 1 month postoperatively., Conclusion: Both AL-LIKE and AU-LIKE exhibit good efficacy and safety in correcting hyperopia. However, AU-LIKE may have a smaller affected area and faster recovery time than those associated with AU-LIKE related to changes in corneal transparency., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To investigate optical zone decentration following femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) or small incision lenticule intrastromal keratoplasty (SMI-LIKE) for correcting hyperopia., Methods: This study analyzed decentration values obtained from optical coherence tomography (OCT) and tangential topography difference maps of 23 eyes (18 patients) undergoing FS-LIKE (n = 12) or SMI-LIKE (n = 11) via the concentric centration method. Total higher order aberrations (HOAs) and component aberrations were measured preoperatively and 6 months postoperatively., Results: The mean optical zone decentration was 0.27 ± 0.08 and 0.39 ± 0.16 mm for the FS-LIKE and SMI-LIKE groups, respectively ( P = .039). A significant difference was noted in lenticule decentration between the two groups (0.18 vs 0.37 mm), whereas no significant difference was observed in stromal bed (pocket) decentration between the two groups (0.10 vs 0.12 mm). Six months after surgery, the spherical equivalent showed a reduction of 6.14 ± 2.44 and 6.10 ± 1.79 diopters (D) for the two groups, respectively ( P = .971), whereas the surgically induced astigmatism was 0.68 ± 0.49 and 1.56 ± 0.78 D for the two groups, respectively ( P = .004). Furthermore, induction of HOAs in the SMI-LIKE group was significantly larger than that in the FS-LIKE group ( P = .013)., Conclusions: FS-LIKE can yield improved treatment centration and less induction of total HOAs. [ J Refract Surg . 2022;38(3):184-190.] .

Purpose: To investigate 2-year visual outcomes, stability, and predictability after allogenic lenticule implantation in a 100-µm pocket for moderate to high hyperopia correction., Methods: In this prospective case series, 14 eyes of 9 patients with moderate to high hyperopia ranging from +3.00 to +8.00 diopters sphere were included between March and September 2018. Allogenic lenticules extracted from myopic small incision lenticule extraction were implanted into a pocket created by femtosecond laser at a 100-µm depth in recipients with hyperopia. All patients were followed up for 2 years. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, corneal topography, Fourier-domain optical coherence tomography, and in vivo confocal microscopy were examined., Results: At postoperative 2 years, 2 eyes (14.3%) gained one line of CDVA, 11 eyes (78.6%) had unchanged CDVA, and 1 eye (7.1%) lost one line of CDVA. No eyes lost two or more lines of CDVA. Twelve of the treated eyes (85.7%) had postoperative uncorrected near visual acuity equal to or better than pre-operative values. The spherical equivalent decreased from +5.53 ± 1.45 D preoperatively to -0.60 ± 1.20 D at postoperative year 2 ( P < .001). The anterior mean keratometric readings increased from 42.41 ± 1.03 D preoperatively to 48.38 ± 1.98 D at postoperative year 2 ( P < .001). Of 14 treated eyes, 10 eyes (71.4%) had spherical equivalent within ±1.00 D., Conclusions: The findings suggest that allogenic lenticule transplantation may be a promising option for the correction of moderate to high hyperopia. [ J Refract Surg . 2021;37(11):734-740.] .

Purpose: To investigate the morphologic and histopathologic changes in allogeneic endokeratophakia using hyperopic lenticules derived from small-incision lenticule extraction (SMILE)., Methods: Six New Zealand rabbits (12 eyes) were included in this experiment and randomly and evenly divided into donor and recipient groups. The donor group underwent bilateral hyperopic SMILE surgery, and the concave lenticules were implanted into eyes in the recipient group. Corneal topography and anterior segment optical coherence tomography (OCT) examinations were performed at 1 day, 1 week, 1 month, and 5 months after surgery. All eyes were enucleated 5 months after surgery. Hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM) were used to observe the corneal morphology in the recipient group., Results: No complications were observed, and the corneas remained transparent in the follow-up period. There was mild corneal edema within 1 week after surgery. Slit-lamp microscopy and OCT showed that the lenticules were gradually integrated with the surrounding corneal stroma. HE staining showed that the arrangement of corneal collagen was regular. The boundary between the lenticules and surrounding tissue could be identified with HE staining and TEM, and no inflammatory cells were found under TEM. The corneal Km values were significantly lower at 5 months postoperatively compared to preoperatively (P < 0.05)., Conclusions: This pilot study showed that allogeneic hyperopic SMILE lenticule endokeratophakia seems to be safe and feasible., Translational Relevance: Allogeneic hyperopic SMILE lenticule endokeratophakia may be applicable for the correction of corneal regression, ectasia, ultra-high myopia, or keratoconus.

Background: We aimed to compare the intraocular pressure (IOP) measurements by a dynamic Scheimpflug analyzer (Corvis ST), a non-contact tonometer, and an ocular response analyzer after hyperopic small-incision lenticule extraction (SMILE)., Methods: Thirteen patients who underwent hyperopic SMILE in one eye were enrolled prospectively. IOP and corneal biomechanical parameters were measured preoperatively and at 1 week, 1 month, and 3 months postoperatively with a non-contact tonometer (IOP NCT ), Corvis ST (biomechanical corrected IOP [bIOP]), and ocular response analyzer (Goldmann-correlated intraocular pressure [IOPg] and cornea compensated IOP [IOPcc]). A linear mixed model was used to compare the IOPs and biomechanical values among methods at each time point., Results: IOP NCT , IOPg, and IOPcc dropped significantly after surgery, with the amplitude being 3.15 ± 0.48 mmHg, 5.49 ± 0.94 mmHg, and 4.34 ± 0.97 mmHg, respectively, at the last follow-up visit. IOP NCT decreased by 0.11 ± 0.06 mmHg per μm of excised central corneal thickness. bIOP did not change significantly after surgery. Preoperatively, no difference was found among the four measurements (P > 0.05). Postoperatively, IOP NCT and bIOP were higher than IOPg and IOPcc. bIOP was independent of cornea thickness at last follow-up visit, whereas it correlated significantly with corneal biomechanics similar to the other three IOP values., Conclusion: bIOP is a relative accurate measure of IOP after hyperopic SMILE.

Purpose: To investigate re-innervation in the implanted lenticule, as well as changes to the cornea, after correcting hyperopia with an autologous implantation of a lenticule obtained through small incision lenticule extraction (SMILE)., Methods: This study retrospectively analysed re-innervation in the implanted lenticule, as well as microscopic morphological changes in the corneal architecture of the recipient cornea in five patients (with myopia in one eye and hyperopia in the contralateral eye) who received SMILE in the myopic eye and femtosecond laser in situ keratomileusis (FS-LASIK) combined with lenticule implantation in the contralateral hyperopic eye. Re-innervation in the implanted lenticule, as well as microscopic morphological changes in corneal architecture, were evaluated by in vivo confocal microscopy., Results: One patient was examined at postoperative week six, two were examined at postoperative month two, one was examined at postoperative month nine, and one was examined at postoperative month 12. Partial subbasal nerve fibre regeneration was detected in two patients (Case 4 who was examined at postoperative month nine and Case 5 who was examined at postoperative month 12). Regenerated and branched nerve fibres were detected in the implanted lenticule in Case 5 who was examined at postoperative month 12. Both the anterior and posterior interfaces showed an absence or decrease of keratocytes and the presence of small particles of various brightnesses. Keratocytes in the implanted lenticule presented abnormal morphology in size and shape after surgery in all treated eyes, but showed partial morphological recovery in two patients (Case 4 who was examined at postoperative month nine and Case 5 who was examined at postoperative month 12)., Conclusions: These preliminary findings suggest that nerve fibres will regenerate into the implanted lenticule after autologous lenticule implantation. Keratocytes in lenticules demonstrated a gradual return to a normal morphology., (© 2017 Optometry Australia.)

Purpose: To create a formula to predict refractive correction of autologous lenticule implantation for correction of hyperopia (with myopia in one eye and hyperopia in the contralateral eye)., Methods: In this prospective study, 10 consecutive patients (20 eyes) who had myopia in one eye and hyperopia in the contralateral eye were included. The preoperative spherical equivalent was -3.31 ± 1.73 diopters (D) for the myopic eyes and +4.46 ± 1.97 D for the hyperopic eyes. For each patient, the myopic eye was treated with small incision lenticule extraction and the lenticule was subsequently implanted into the contralateral hyperopic eye. The average length of follow-up was 17 months., Results: All of the operations were successful without complications. At the last visit, the efficacy index (postoperative uncorrected distance visual acuity/preoperative corrected distance visual acuity [CDVA]) of the hyperopic eyes was 0.94 ± 0.35 and the safety index (postoperative CDVA/preoperative CDVA) was 1.36 ± 0.38. No eyes lost any lines of visual acuity. Six of 10 (60%) of the implanted eyes were within ±1.00 D of the intended refractive target. A predictive formula was derived: Lenticule implantation achieved correction (D) (LAC) = 1.224 Lenticule refractive power (D) (LRP) - 0.063 (R 2 =0.92, P < .001). On corneal topography, there was a significant increase in the corneal anterior surface keratometry value postoperatively, whereas the posterior surface keratometry value remained stable (P > .05)., Conclusions: Autologous lenticule implantation could provide a reliable method of correcting hyperopia. The refractive correction formula may require further verification and adjustment. [J Refract Surg. 2017;33(12):827-833.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To evaluate the safety, effectiveness, stability, and predictability of implanting autologous lenticules obtained from small incision lenticule extraction for the treatment of hyperopia., Methods: Five patients (10 eyes) with one myopic eye and one hyperopic eye were enrolled. The myopic eye was treated with small incision lenticule extraction; a lenticule was extracted and subsequently implanted in the hyperopic eye. Follow-up was at 1 day, 1, 3, 6, and 9 months, and 1 year postoperatively. Patients received a complete ophthalmologic examination at each visit, including uncorrected distance visual acuity, corrected distance visual acuity, anterior segment optical coherence tomography, and corneal topography., Results: There were no complications in any eye during follow-up. Compared with preoperative levels, at the last follow-up visit the eyes with lenticule implantation showed mean spherical equivalent reduced by 5.53 diopters (residual spherical equivalent was +1.13 to -2.63 diopters), mean uncorrected distance visual acuity increased approximately two lines (approximately 20/63 to 20/40 Snellen), and corrected distance visual acuity in 4 (80%) eyes gained one line, 2 (40%) eyes gained two lines, and 1 (20%) eye gained more than two lines. There was no significant difference (P > .05) in spherical equivalent compared with 1 day postoperatively and the last follow-up visit. Corneal topography showed that the lenticule was uniform and located well; anterior segment optical coherence tomography images showed that the lenticule was transparent and the demarcation line was visible., Conclusions: Implanting an autologous lenticule obtained by small incision lenticule extraction for hyperopia might be safe, effective, and stable, but its predictability should be improved in the future., (Copyright 2015, SLACK Incorporated.)

Aim: This study aimed to evaluate the visual outcomes and corneal densitometry (CD) after allogenic lenticule intrastromal keratoplasty (AL-LIKE) and autologous lenticule intrastromal keratoplasty (AU-LIKE) for the correction of moderate-to-high hyperopia. Methods: Ten subjects (14 eyes) underwent AL-LIKE and eight (8 eyes) underwent AU-LIKE. Patients were examined preoperatively and 1 day, 1 month, and 6 months postoperatively. The visual outcomes and CD for both surgical methods were evaluated. Results: No postoperative complications were observed with either method. The efficacy index was 0.85±0.18 and 0.90±0.33 in the AL-LIKE and AU-LIKE groups, respectively. The safety indices were 1.07±0.21 and 1.25±0.37 in the AL-LIKE and AU-LIKE groups, respectively. The CD values of the anterior, central, and posterior layers in the AL-LIKE group increased significantly at 1 day postoperatively (all P < 0.05). The CD values of the anterior and central layers remained significantly higher than the preoperative values at 6 months postoperatively (all P < 0.05). The CD values of the anterior layer in the AU-LIKE group increased significantly 1 day postoperatively (all P < 0.05) and decreased to preoperative values (all P > 0.05) 1 month postoperatively. Conclusion: Both AL-LIKE and AU-LIKE exhibit good efficacy and safety in correcting hyperopia. However, AU-LIKE may have a smaller affected area and faster recovery time than those associated with AU-LIKE related to changes in corneal transparency. [ABSTRACT FROM AUTHOR]

Introduction: To investigate nighttime symptoms in patients with myopic anisometropia after monocular small incision lenticule extraction (SMILE) surgery. Methods: Thirty-six patients who had undergone monocular SMILE more than 6 months previously were recruited at the Eye & ENT Hospital of Fudan University. The average age at surgery was 25.4 ± 6.1 years. Preoperative spherical equivalent (SE) was −3.77 ± 1.56 D in SMILE-treated eyes and −0.08 ± 0.66 D in unoperated eyes. Main measurements included uncorrected and corrected distance visual acuity, manifest refraction, halo radius, contrast sensitivity, nighttime symptoms, and patient satisfaction. Results: The mean follow-up time was 13.9 ± 3.4 months. The efficacy and safety indexes were 1.18 and 1.28, respectively. The halo radius was not significantly different between SMILE-treated and unoperated eyes under luminance conditions of 1, 5, and 100 cd/m2 (P = 0.055). No significant differences were observed in contrast sensitivity at all spatial frequencies between eyes under both uncorrected and corrected conditions (all P > 0.05). None of the patients reported moderate or severe symptoms at night. Mild symptoms (glare, halo, starburst) were reported and binocularly equal in 13 patients, whereas four patients reported better night vision in SMILE-treated eyes than unoperated eyes, and one of them experienced mild night vision disturbance. The overall satisfaction score was 9.39 ± 0.80. Conclusions: The disk halo size and contrast sensitivity in SMILE-treated eyes were similar to those in unoperated eyes, and nighttime symptoms almost completely resolved after SMILE. [ABSTRACT FROM AUTHOR]