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