Twelve months' follow-up of intrastromal keratoplasty: new perspectives for the treatment of keratoconus

Session Details

Session Title: Keratoconus

Session Date/Time: Monday 16/09/2019 | 14:00-16:00

Paper Time: 15:12

Venue: Free Paper Forum: Podium 2

First Author: : E.Pedrotti ITALY

Co Author(s): :    E. Bonacci   T. Cozzini   J. Bonetto   T. Merz   P. Talli   G. Marchini              

Abstract Details

Purpose:

Keratoplasty is the gold standard for keratoconus management but invasiveness, high post-operative astigmatism and risk of rejection remain the major complications related to this surgery. We investigate the outcomes after mini-invasive intrastromal lenticule implantation (intrastromal keratoplasty) in ectatic corneas with 12 months follow up.

Setting:

Accademic. Eye Clinic University of Verona

Methods:

This prospective interventional study included 10 eyes of 10 patients with keratoconus eligible for transplantation which underwent intrastromal keratoplasty. Preoperative evaluation included pachimetry and corneal tomography. Stromal meniscus-shaped lenticules were sculpted from human donor corneas by means of femtosecond laser, with the same diameter and thickness of the ectasias. Keratoconic corneas underwent femtosecond assisted intrastromal pocket creation within the ectatic area. After marking the center of both the keratoconus and lenticule, the latter was inserted into the pocket, ensuring their alignment. No sutures were necessary. Changes of corneal architecture and keratometric parameters were investigated.

Results:

All lenticule insertions were performed succesfully without complications. Anterior segment OCT confirmed the correct lenticular profile inside the stromal pocket. Central corneal thickness and thinnest point showed statistically significant differences between pre and postoperative evaluations (p = <0.0001) with resolution of corneal swelling between 6 and 9 month postoperatively. Anterior elevation was significantly reduced (p = 0.04). No transplant rejection was observed. Posterior elevation and the surface asymmetry index don’t show statistically significant change at 12 months, despite showing tendency to improvement.

Conclusions:

Intrastromal keratoplasty in ectatic corneas shows a remarkable improvement in corneal architecture and stability. This mini-invasive surgery show less immune risk and it preserves the possibility to perform the traditional surgery subsequently. The Intrastromal keratoplasty may open new perspectives to the treatment of keratoconus.

Financial Disclosure:

gains financially from competing product or procedure, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, receives non monetary benefits from a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, is employed by a competing company, has significant investment interest in a company producing, developing or supplying product or procedure presented