Toric Lenticule Implantation for Correction of Hyperopia and Astigmatism Following Small Incision Lenticule Intrastromal Keratoplasty With the Triple Marking Method.

Abstract

To describe the first use of toric lenticule implantation with the triple marking method to correct hyperopia and hyperopic astigmatism following small incision lenticule intrastromal keratoplasty (SMI-LIKE). Five eyes of four patients with hyperopia (+5.25 to +9.50 diopters sphere) were included. Allogenic toric lenticules extracted using myopic small incision lenticule extraction were implanted and rotated into a femtosecond laser-created stromal pocket in hyperopic recipients with triple marking. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, corneal topography, and Fourier-domain optical coherence tomography images were examined 6 months postoperatively. Six months after surgery, 4 eyes (80%) gained two or more lines of UDVA, and 1 eye (20%) had unchanged UDVA. No eyes lost any lines of CDVA. The spherical equivalent decreased from +6.23 ± 1.34 diopters (D) preoperatively to -0.35 ± 0.27 D postoperatively. The mean refractive astigmatism also decreased significantly from -2.15 ± 1.10 D preoperatively to -0.70 ± 0.21 D postoperatively. Of 5 treated eyes, 2 (40%) had postoperative astigmatism within ±0.50 diopters cylinder and 5 (100%) within ±1.00 diopters cylinder. Corneal topography showed a significant increase in the anterior surface keratometry value, whereas corneal astigmatism decreased from 2.62 ± 1.55 to 1.10 ± 0.44 D. Vector analyses suggested good predictability and efficacy for astigmatism correction. Implantation of toric lenticules following SMI-LIKE with the triple marking method is a feasible alternative for correcting hyperopia and hyperopic astigmatism, and the short-term results seem safe and stable. [J Refract Surg. 2022;38(2):82-88.].