Application of the SMILE-derived lenticule in therapeutic keratoplasty

Purpose To observe the clinical efficacy of the small incision lenticule extraction (SMILE)-derived lenticule patch graft in therapeutic keratoplasty, especially for the treatment of corneal microperforation or partial-thickness corneal defects. Methods Corneal lenticule obtained from SMILE surgery with diameter greater than 6.5 mm and thickness greater than 100 μm was preserved in a balanced salt solution (Alcon Laboratories, Fort Worth, TX) containing 50 mg/mL penicillin, 50 mg/mL streptomycin, 100 mg/mL neomycin, and 2.5 mg/mL amphotericin for at least 3 months. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the ulcer and to decide the thickness of the lenticule. Patients were followed up on day 1 and then at 1, 3, and 6 months postoperatively. Results Corneal perforation or defects were successfully patched in all 17 eyes; 8 eyes (47%) exhibited improvement postoperative corrected distance visual acuity. During the follow-up period of 6 months, there was no evidence of infection, relapse, or perforation detected in all eyes. Lenticule grafts were attached by graft beds very well and remain clear through to the last follow-up checkup in all eyes treated. Conclusions The lenticule patch graft seems to serve as a safe, feasible, and inexpensive surgical option for the treatment of keratohelcosis or partial-thickness corneal defects, especially in small perforation and defects. There are hopeful signs that SMILE-derived lenticule becomes a potential graft for therapeutic keratoplasty.