Outcomes of Femtosecond  Intrastromal  Lenticule  Implantation: Tissue Addition Technique  Combined With Accelerated CXL for Mild to Moderate Keratoconus

Saturday, April 18, 2015: 4:16 PM
Room 5B (San Diego Convention Center)
Sri Ganesh, MBBS, MS, DNB
Sheetal Brar, MD

To study the safety, visual and clinical outcomes of FILI for treatment of mild to moderate   keratoconus when combined with accelerated crosslinking.

Study included eyes with mild to moderate keratoconus, evidence of progression, minimum pachy  400 µm, ECD > 1500 cells/mm2. 6 eyes of 6 patients were treated. Femtosecondlaser was used to create a pocket  in patients cornea, into which 0.25% riboflavin was injected and soaked for 60 sec . A doughnut shaped cryopreserved lenticule (extracted after SMILE and punched with 3 mm trephine in centre ) was then inserted into pocket and centered on pupillary axis. Eye was exposed to UV-A radiation at 30 Mw/cm2  for 3.3 min. Topical steroids prescribed for 3 months.

Six eyes of 6 patients with mean age 19.5  years, SE -2.91±0.84 D, cylinder -3.37 ±1.64  and  CDVA  20/80 were treated. 15 days postoperative - mean UCVA , CDVA , residual SE, cylinder  was 20/40, 20/40, -1.47±2.0 D and -2.62±1.53 D respectively.  Keratometery decreased from 51.13 ± 6.4 to 48.65±7.31 D and central pachymetery increased from 436.2±46.3 to 440.3±28.6 µm. At 3 month follow-up corneal parameters and ECD were stable with no  statistically significant changes from 15 days values (p>0.05). No adverse events or rejection occured until the end of mean follow-up.

Combined FILI with KXL appears to be safe modality in stabilizing progressive keratoconus. Potential advantages - no risk of extrusions or infections as in intracorneal rings, painless and quick healing and reversibility. Longer follow-up is required to establish long-term efficacy.