Lenticule intrastromal keratoplasty (LIKE) for presbyopia

Session Details

Session Title: Corneal Presbyopia & Astigmatism Correction

Session Date/Time: Tuesday 17/09/2019 | 16:30-18:00

Paper Time: 16:30

Venue: Free Paper Forum: Podium 3

First Author: : T.Seiler SWITZERLAND

Co Author(s): :    M. Jankov   T. Seiler                          

Abstract Details

Purpose:

To evaluate the outcome of lenticule intrastromal keratoplasty (LIKE) for presbyopia treatment. During LIKE, a lenticule of human corneal stroma, 7mm in diameter is placed under a 10mm wide LASIK-flap. Hitherto, this technique is used for hyperopia correction in cases where LASIK or phakic IOLs are not applicable.

Setting:

Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Switzerland.

Methods:

Non-dominant eyes of 19 emmetropic phakic patients were treated in order to achieve monovision. Intended correction ranged from +1.0 to +1.75 diopters and a preoperative contact lens test was undertaken to prove acceptance. Prior to surgery, the amplitude of pupil reaction was measured. The aspheric lenticules with a Q-factor of -1.0 were created using a mechanical microkeratome with micrometer-precision (Gebauer, Germany) from human donor corneas not elected for transplantation and contained an intact Bowman´s layer at the anterior surface. The lenticules were positioned under a LASIK-flap (110microns) centered on the middle between Purkinje-image and center of the entrance pupil.

Results:

Surgery and early post-operative follow-up was uneventful; no adverse reactions were seen. Repositioning of the lenticule was necessary in 3 eyes at 1 week after surgery. At 1 month, in 4 eyes (21%) a relift was necessary for topography-guided correction of residual astigmatism on the lenticule using an excimer laser (Amaris 1050, Schwind, Germany). The Q-factor decreased from -0.09±0.18 to -0.78±0.15 at 6 months. Binocular UNVA increased on average from 0.16 to 0.63 under environment lightning of 200cd/m2. In 1 patient, the lenticule was removed because of dissatisfaction without any visual loss in BSCVA.

Conclusions:

In this first series of LIKE for presbyopia results were obtained that are similar to those achieved by LASIK or other inlays, however, this approach has no impact on stromal diffusion and is fully reversible. Longer follow-up and larger study groups are necessary.

Financial Disclosure:

None