Case Reports

Management of a case of bilateral keratectasia post ReLEx-SMILE, using tissue addition and pocket cross-linking

Case Report Details

First Author: S.Sute INDIA

Co Author(s):    S. Ganesh   S. Brar                 

Abstract Details

Purpose:

To describe a novel technique of management of a case of keratectasia post ReLEx-SMILE, using tissue addition and accelerated collagen cross linking in pocket.

Setting:

Nethradhama Super Speciality Eye Hospital, Bangalore, India

Report of Case:

Method: A 23 year old male, with pre-op refraction of -3DS/-1.65DC@165 OD and -6.65DS/-0.75DC@170 OS respectively underwent ReLEx-SMILE. At 2 week post SMILE, his UDVA was 6/6 OU, after which the patient did not come for follow-up. Three years later, he presented with complaints of difficulty in focusing while working on computer. On examination, his UDVA was 6/18 in right and 6/24 in the left eye. His CDVA improved with a refraction of-1.00/-2.50@170 to 6/12 in the right eye and with -1.00/-2.75@170 to 6/12p in the left eye. His pre-operative Pentacam tomography showed normal quad maps and BAD displays in both eyes, except one borderline parameter. The case was managed with insertion of a doughnut shaped heterologous corneal tissue prepared from donor SMILE lenticules matched for spherical equivalent(SE), followed by simultaneous accelerated cross linking in the pocket. Result: At 6 months follow-up, there was an improvement in CDVA with reduction in the steep keratometry and higher order aberrations both the eyes. The visual, refractive and topographic parameters remained stable at 1 year compared to 2 weeks follow-up. No eye developed haze, infection, stromal rejection or required explantation of the tissue.

Conclusion/Take Home Message:

Conclusion- Tissue addition with simultaneous pocket cross linking may be a safe and feasible approach to manage post SMILE ectasia. However, long term follow-ups are required to establish its effects on corneal stabilization.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a competing company