Abstract
Implantation of biological corneal inlays, derived from small incision lenticule extraction, may be a feasible method for surgical management of refractive and corneal diseases. However, the refractive outcome is dependent on stromal remodelling of both the inlay and recipient stroma. This study aimed to investigate the refractive changes and tissue responses following implantation of 2.5-mm biological inlays with or without corneal collagen crosslinking (CXL) in a rabbit model. Prior to implantation, rotational rheometry demonstrated an almost two-fold increase in corneal stiffness after CXL. After implantation, haze gradually subsided in the CXL-treated inlays (p = 0.001), whereas the untreated inlays preserved their clarity (p = 0.75). In-vivo confocal microscopy revealed reduced keratocyte cell count at the interface of the CXL inlays at week 8. Following initial steepening, regression was observed in anterior mean curvature from week 1 to 12, being most prominent for the non-CXL subgroups (non-CXL: −12.3 ± 2.6D vs CXL: −2.3 ± 4.4D at 90 μm depth, p = 0.03; non-CXL: −12.4 ± 8.0D vs CXL: −5.0 ± 4.0D at 120 μm depth, p = 0.22). Immunohistochemical analysis revealed comparable tissue responses in CXL and untreated subgroups. Our findings suggest that CXL of biological inlays may reduce the time before refractive stabilization, but longer postoperative steroid treatment is necessary in order to reduce postoperative haze.
Highlights
Presbyopia is an age-related physiological condition with gradual loss of accommodation, that causes an inability to focus at near distance[1]
Small incision lenticule extraction (SMILE) for myopia and myopic astigmatism involves the creation of an intrastromal lenticule using the VisuMax 500-kHz femtosecond laser (Carl Zeiss Meditec, Jena, Germany)[10,11]
Meniscus and doughnut shaped biological inlays have previously been used for anterior corneal curvature flattening in patients with keratoconus[16,18,20] while plano-convex shaped lenticules have been used for corneal perforations[23]
Summary
Presbyopia is an age-related physiological condition with gradual loss of accommodation, that causes an inability to focus at near distance[1]. The plano-convex shaped stromal lenticule is extracted through a small incision to flatten the anterior surface. For surgical management of presbyopia, the biological inlays may act as a shape changing inlay, that creates a central hyperprolate contour for near and intermediate vision[9], similar to what is seen following implantation of the Raindrop inlay[9,14]. We have previously demonstrated in non-human primates that lenticule implantation of the central 3-mm of a −3D SMILE derived lenticule effectively caused a hyperprolate shape change[9]. The aim of this study was to examine the corneal topography and stromal remodulation following implantation of SMILE-derived CXL treated and non-CXL treated biological inlays
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