Abstract
Stromal lenticule addition keratoplasty (SLAK) is a novel, minimally invasive technique for the treatment of advanced keratoconus in patients with poor vision or contact lens intolerance. A femtosecond laser-shaped lenticule of donor stroma, sculpted by means of femtosecond laser, is implanted into an intrastromal pocket in the recipient cornea. Implanted tissue produces a significant flattening of the cone combined with an increase of the corneal thickness consistent with the thickness profile of the lenticule. These results proved to be stable after 2 years of follow-up, with no evidence of rejection. High-resolution anterior segment-optical coherence tomography (AS-OCT) is an imaging technique necessary in all SLAK surgical phases. In preoperative time it allows to evaluate patient eligibility assessing corneal clarity, stromal and epithelial thickness, and cone apex eccentricity. Intraoperative AS-OCT is useful to detect proper centration and distention of the lenticule in real time. After surgery it allows one to evaluate surgical results and follow them up over time, providing important information about corneal morphological changes. In summary, AS-OCT imaging is essential to approach this novel intrastromal additive corneal surgery.
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References
Barraquer JI. Refractive corneal surgery. Experience and considerations. An Inst Barraquer. 1993;24:113–8.
Barraquer JI. Modification of refraction by means of intracorneal inclusion. Int Ophthalmol Clin. 1966;6(1):53–78.
Arnalich-Montiel F, Alió del Barrio JL, Alió JL. Corneal surgery in keratoconus: which type, which technique, which outcomes? Eye Vis (Lond). 2016;3:2.
Choi JA, Kim MS. Progression of keratoconus by longitudinal assessment with corneal topography. Invest Ophthalmol Vis Sci. 2012;53:927–35.
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.
Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-a light in keratoconus: long-term results. J Cataract Refract Surg. 2008;34:796–801.
Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol. 2010;149:585–93.
Toprak I, Yaylalı V, Yildirim C. Factors affecting outcomes of corneal collagen crosslinking treatment. Eye (Lond). 2014;28:41–6.
Parker JS, van Dijk K, Melles GR. Treatment options for advanced keratoconus: a review. Surv Ophthalmol. 2015;60:459–80.
Henein C, Nanavaty MA. Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye. 2017;40:3–14.
Mastropasqua L. Collagen cross-linking: when and how? A review of the state of the art of the technique and new perspectives. Eye Vis (Lond). 2015;2:19.
Ertan A, Colin J. Intracorneal rings for keratoconus and keratectasia. J Cataract Refract Surg. 2007;33(7):1303–14.
Mastropasqua L, Nubile M, Salgari N, Mastropasqua R. Femto-second laser assisted stromal lenticule addition keratoplasty. J Refract Surg. 2018;34(1):36–44.
Alió Del Barrio JL, El Zarif M, Azaar A, Makdissy N, Khalil C, Harb W, et al. Corneal stroma enhancement with decellularized stromal laminas with or without stem cell recellularization for advanced keratoconus. Am J Ophthalmol. 2018;186:47–58. https://doi.org/10.1016/j.ajo.2017.10.026.
Liu R, Zhao J, Xu Y, Li M, Niu L, Liu H, et al. Femtosecond laser-assisted corneal small incision allogenic intrastromal lenticule implantation in monkeys: a pilot study. Invest Ophthalmol Vis Sci. 2015;56:3715–20.
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.
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.
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.
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.
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 re-implantation after refractive lenticule extraction. PLoS One. 2013;8:e67058.
Jacob S, Kumar DA, Agarwal A, Agarwal A, Aravind R, Saijimol AI. Preliminary evidence of successful near vision enhancement with a new technique: PrEsbyopic allogenic refractive Lenticule (PEARL) corneal inlay using a SMILE lenticule. J Refract Surg. 2017;33:224–9.
Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye Vis (Lond). 2014;16:3.
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.
Mastropasqua L, Nubile M. Corneal thickening and central flattening induced by femtosecond laser hyperopic-shaped intrastromal lenticule implantation. Int Ophthalmol. 2017;37:893–904.
Stulting RD, Sugar A, Beck R, Belin M, Dontchev M, Feder RS, et al. Effect of donor and recipient factors on corneal graft rejection. Cornea. 2012;31:1141–7.
Panda A, Vanathi M, Kumar A, Dash Y, Priya S. Corneal graft rejection. Surv Ophthalmol. 2007;52:375–96.
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Leonardo Mastropasqua, Mario Nubile, Niccolò Salgari, Jessica Bondì, Emanuele Erroi, and Luca Cerino declare that they have no conflict of interest.
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Mastropasqua, L., Nubile, M., Salgari, N., Bondì, J., Erroi, E., Cerino, L. (2021). Anterior Segment OCT: Application in Stromal Lenticule Addition Keratoplasty (SLAK). In: Alió, J.L., del Barrio, J.L.A. (eds) Atlas of Anterior Segment Optical Coherence Tomography. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-53374-8_10
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