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Corneal stromal filler injection: a novel approach to correct presbyopia

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First Author: S.Kassumeh GERMANY

Co Author(s):    J. Luther   S. Priglinger   A. Wartak   G. Apiou-Sbirlea   R. Anderson   R. Birngruber     

Abstract Details

Purpose:

Current studies estimate presbyopia to affect nearly 25% of the population worldwide. Surgical treatment options range from laser-ablative surgeries and corneal implants to lens refractive surgeries, sometimes facing complications such as reduced visual acuity, glare and halos. The aim of our study was to evaluate the potential of the corneal stromal filler injection as a new bifocal approach to correct presbyopia.

Setting:

All experiments were conducted on rabbit eyes ex vivo in the Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Methods:

Using a clinical femtosecond laser system, stromal pockets with a distance of 60 – 300 µm to the posterior corneal surface and different diameters (3 mm and 2 mm) were cut into the central stroma of rabbit eyes (n = 57). Hyaluronic acid was injected into the pocket via a manually created channel. The subsequent flattening of the central posterior corneal curvature should increase the central refractive power and create corneal bifocality. Refractive changes were quantified using three-dimensional optical coherence tomography (OCT) perioperatively. Using micrometer-resolution OCT, corneal endothelial cell morphology and density was evaluated.

Results:

When injecting filler into the corneal pocket, a decent volume-dependent increase of central refractive power up to 4 dpt was observed. Refractive changes of the peripheral posterior (3 mm: 0.20 ± 0.11 dpt; 2 mm: 0.11 ± 0.10 dpt) and the anterior corneal surface (3 mm: 0.20 ± 0.34 dpt, p = 0.362; 2 mm: 0.33 ± 0.31 dpt, p = 0.166) were unremarkable. No relevant astigmatic changes were observed. Different sizes of optical zones could be established. Furthermore, no alterations of corneal endothelial morphology or endothelial cell density (p = 0.552) due to the adjacent laser impact were observed.

Conclusions:

Our results proved the principle of the corneal filler injection as a novel treatment to create bifocality and thus correct presbyopia ex vivo. A major advantage is the adjustability to the individuals’ needs and the non-ablative approach.

Financial Disclosure:

... receives non-monetary benefits from a company producing, developing or supplying the product or procedure presented