Small-Incision Femtosecond Refractive Lenticule–Assisted Corneal CXL in Corneal Ectasia
To evaluate epi–off corneal collagen crosslinking (CXL) using refractive stromal lenticule of another patient undergoing small incision femtosecond lenticule extraction, in patients having keratectasia with thinnest pachymetry value of less than 400 microns and not treatable using standard de-epithelialization techniques.
Five patients affected by progressive keratectasias (3 keratoconus and 2 post-LASIK keratectasia) with thinnest pachymetry values ranging from 360 μm to 397 μm underwent CXL using a modified technique, using refractive stromal lenticule from patients undergoing small incision femtosecond lenticule extraction for moderate myopia (-2 to -4) on Visumax and thickness ranging from 110 to 120 µm. Epithelium was debrided and stromal lenticule 6.0 mm in diameter, harvested simultaneously, was placed so that the center corresponded to the apex of the cone. Riboflavin 0.1 % drops were put and CXL carried out in the standard manner The patients underwent complete ophthalmological examination, including endothelial cell density measurements and Scheimpflug imaging, before CXL and at 1, 6, and 12 months thereafter.
Epithelial healing was complete in all patients within 5 days of use of a soft bandage contact lens. No side effects or damage to the limbal region was observed during the follow-up period. All patients showed stability of K readings after 6 months. Demarcation line was observed in all the cases.
The new technique of using refractive stromal lenticule for CXL increases the corneal thickness in most physiological way. In our series, it was found to be a safe, effective and viable alternative to enhance corneal thickness during CXL in patients with keractectasia having thin or ultrathin corneas.