Double small incision lenticule extraction lenticular graft in impending corneal perforation

Abstract

Purpose The aim of this study was to evaluate the safety and efficacy of double stromal lenticules, extracted by femtolaser small incision lenticule extraction (SMILE) surgery, as a surgical adjuvant for sealing of impending corneal perforation. Patients and methods The study included 20 eyes of 20 patients with impending corneal perforation. Double corneal stromal lenticules obtained through SMILE surgery, with a central thickness of 65 μm for each lenticule, were fixed over the corneal impending perforation site by 10-0 nylon interrupted stitches. The patients were monitored for a minimum of 6 months and were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity measurements. Postoperative complications were recorded throughout the follow-up period. Results The mean age of the patients was 51.25±1.49 years. The mean thickness of the used double SMILE lenticules was 108.85±10.77 μm (range, 90–120 μm). The preoperative best spectacle-corrected visual acuity was counting fingers at 30 cm in four patients, whereas the other 16 patients had a visual acuity of hand movement. Postoperatively, the corneal perforations were successfully sealed in 16 (80%) patients, and 15 (75%) patients exhibited a statistically significant improvement in visual acuity (P=0.02). During the follow-up period of 6 months, there was evidence of one case of infection and two cases of sliding graft. There was no significant association between the patients’ data and the reported complications except the association between complications and hand movement visual acuity. Conclusion The use of double corneal lenticules was a safe and effective surgical adjuvant for corneal perforation closure. It is a simple and inexpensive temporary measure to improve the corneal condition for further definitive interventions.