Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(1):55-61 | DOI: 10.5507/bp.2023.004

Corneal stromal lenticule transplantation for the treatment of corneal ulcers

Yun Min Klimesova1, Martina Nemcokova1, Magdalena Netukova1, Alina-Dana Baxant1, Marcela Hlavackova2, Jana Kacerovska2, Pavel Studeny1
1 Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic
2 Eye Clinic Horni Pocernice, Czech Republic

Purpose. To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers. Methods. This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months. Results. In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient.

Conclusion: The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation.

Keywords: corneal ulcer, corneal stromal lenticule, ReLEx SMILE, amniotic membrane, CSL transplantation

Received: July 30, 2022; Revised: November 10, 2022; Accepted: January 6, 2023; Prepublished online: January 25, 2023; Published: March 12, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Min Klimesova, Y., Nemcokova, M., Netukova, M., Baxant, A., Hlavackova, M., Kacerovska, J., & Studeny, P. (2024). Corneal stromal lenticule transplantation for the treatment of corneal ulcers. Biomedical papers168(1), 55-61. doi: 10.5507/bp.2023.004
Download citation

References

  1. Portnoy SL, Insler MS, Kaufman HE. Surgical management of corneal ulceration and perforation. Surv Ophthalmol 1989;34:47-58. Go to original source... Go to PubMed...
  2. Jhanji V, Young AL, Mehta JS, Sharma N, Tushar Agarwal, Vajpayee RB. Management of corneal perforation. Surv Ophthalmol 2011;56:522-38. doi: 10.1016/j.survophthal.2011.06.003 Go to original source... Go to PubMed...
  3. Khalifa YM, Bailony MR, Bloomer MM, Killingsworth D, Jeng BH. Management of nontraumatic corneal perforation with tectonic drape patch and cyano-acrylate glue. Cornea 2010;29:1173-5. Go to original source... Go to PubMed...
  4. Setlik DE, Seldomridge DL, Adelman RA, Semchyshyn TM, Afshari NA. The effectiveness of isobutyl cyanoacrylate tissue adhesive for the treatment of corneal perforations. Am J Ophthalmol 2005;140:920-1. Go to original source... Go to PubMed...
  5. Chan E, Shah AN, O'Brart DP. "Swiss roll" amniotic membrane technique for the management of corneal perforations. Cornea 2011;30:838-41. Go to original source... Go to PubMed...
  6. Ti SE, Scott JA, Janardhanan P, Tan DTH. Therapeutic keratoplasty for advanced suppurative keratitis. Am J Ophthalmol 2007;143(5):755-62. Go to original source... Go to PubMed...
  7. Mohamed-Noriega K, Toh KP, Poh R, Balehosur D, Riau A, Htoon HM, Peh GS, Chaurasia SS, Tan DT, Mehta JS. Cornea lenticule viability and structural integrity after refractive lenticule extraction (ReLEx) and cryopreservation. Mol Vis 2011;17:3437-49.
  8. Angunawela RI, Riau AK, Chaurasia SS, Tan DT, Mehta JS. Refractive lenticule re-implantation after myopic ReLEx: a feasibility study of stromal restoration after refractive surgery in a rabbit model. Invest Ophthalmol Vis Sci 2012;53:4975-85. Go to original source... Go to PubMed...
  9. Liu H, Zhu W, Jiang AC, Sprecher AJ, Zhou X. Femtosecond laser lenticule transplantation in rabbit cornea: experimental study. J Refract Surg 2012;28:907-11. Go to original source... Go to PubMed...
  10. Riau AK, Angunawela RI, Chaurasia SS, Lee WS, Tan DT, Mehta JS. Reversible femtosecond laser-assisted myopia correction: a non-human primate study of lenticule reimplantation after refractive lenticule extraction. PLoS One 2013;8:e67058. Go to original source... Go to PubMed...
  11. Lim CH, Riau AK, Lwin NC, Chaurasia SS, Tan DT, Mehta JS. LASIK following small incision lenticule extraction (SMILE) lenticule re-implantation: a feasibility study of a novel method for treatment of presbyopia. PLoS One 2013;8:e83046. Go to original source... Go to PubMed...
  12. Liu R, Zhao J, Xu Y, Li M, Niu L, Liu H, Sun L, Chu R, Zhou X. Femtosecond laser-assisted corneal small incision allogenic intrastromal lenticule implantation in monkeys: a pilot study. Invest Ophthalmol Vis Sci 2015;56:3715-20. Go to original source... Go to PubMed...
  13. Pradhan KR, Reinstein DZ, Carp GI, Archer TJ, Gobbe M, Gurung R. Femtosecond laser-assisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor. J Refract Surg 2013;29:777-82. Go to original source... Go to PubMed...
  14. Ganesh S, Brar S, Rao PA. Cryopreservation of extracted corneal lenticules after small incision lenticule extraction for potential use in human subjects. Cornea 2014;33:1355-62. Go to original source... Go to PubMed...
  15. Sun L, Yao P, Li M, Shen Y, Zhao J, Zhou X. The safety and predictability of implanting autologous lenticule obtained by SMILE for hyperopia. J Refract Surg 2015;31:374-9. Go to original source... Go to PubMed...
  16. Ganesh S, Brar S. Femtosecond intrastromal lenticular implantation combined with accelerated collagen cross-linking for the treatment of keratoconus - initial clinical result in 6 eyes. Cornea 2015;34:1331-9. Go to original source... Go to PubMed...
  17. Lazaridis A, Reinstein DZ, Archer TJ, Schulze S, Sekundo W. Refractive Lenticule Transplantation for correction of iatrogenic hyperopia and high astigmatism after LASIK. J Refract Surg 2016;32:780-6. Go to original source... Go to PubMed...
  18. Boruchoff SA, Donshik PC. Medical and surgical management of corneal thinnings and perforations. Int Ophthalmol Clin 1975;15:111-23. Go to original source... Go to PubMed...
  19. Raychaudhuri A, Raychaudhuri M, Banerjee AR. Availability of donor corneal tissue for transplantation. Trop Doct 2004;34:99-101. Go to original source... Go to PubMed...
  20. Wu F, Jin X, Xu Y, Yang Y. Treatment of corneal perforation with lenticules from small incision lenticule extraction surgery: a preliminary study of 6 patients. Cornea 2015;34(6):658-63. Go to original source... Go to PubMed...
  21. Jiang Y, Li Y, Liu XW, Xu J. A novel tectonic keratoplasty with femtosecond laser intrastromal lenticule for corneal ulcer and perforation. Chin Med J (Engl) 2016;129:1817-21. Go to original source... Go to PubMed...
  22. Bhandari V, Ganesh S, Brar S. Application of the SMILE-derived glued lenticule patch graft in microperforations and partial-thickness corneal defects. Cornea 2016;35(3):408-12. Go to original source... Go to PubMed...
  23. Abd Elaziz MS, Zaky AG, El SaebaySarhan AR. Stromal lenticule transplantation for management of corneal perforations; one year results. Graefes Arch Clin Exp Ophthalmol 2017;255:1179-84. Go to original source... Go to PubMed...
  24. Al Saadany AI, El Gouhary SM, Abd Elaziz MS, Basiony AI, Al Sayed Omara A. Amniotic membrane versus corneal stromal lenticule grafting for the management of corneal perforations: a retrospective study. Delta J Ophthalmol 2019;20:22-7. Go to original source...
  25. Baum J. Thygeson lecture. Amniotic membrane transplantation: why is it effective? Cornea 2002;21:339-41. Go to original source... Go to PubMed...
  26. Nubile M, Dua HS, Lanzini TE, Carpineto P, Ciancaglini M, Toto L, Mastropasqua L. Amniotic membrane transplantation for the management of corneal epithelial defects: an in vivo confocal microscopic study. Br J Ophthalmol 2008;92:54-60. Go to original source... Go to PubMed...
  27. Tseng SC, Li DQ, Ma X. Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix. J Cell Physiol 1999;179:325-53. Go to original source...
  28. Rodriguez-Ares MT, Tourino R, Lopez-Valladares MJ, Gude F. Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea 2004;23:577-83. Go to original source... Go to PubMed...

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.