LONG TERM RESULTS OF LENTICULE TRANSPLANTATION FOR HIGH HYPEROPIA AND ASTIGMATISM

To investigate the safety, efficacy and corneal changes after myopic lenticule transplantation in patients with high hyperopia and astigmatism.

Eye Hospital, Prishtina, Kosovo

This restrospective study included forty eyes from thirty patients aged 20 to 45 years, with refractive errors between +4.0 D and +6.50 D, and astigmatism ranging from +1.0 D to +3.0 D. The preoperative central corneal thickness (CCT) varied from 450 μm to 550 μm. The exclusion criteria for this study included a corneal thickness greater than 550 µm, a history of glaucoma, retinal detachment, cataracts, and a history of ocular inflammation.

Donor lenticules were sourced from patients who underwent small incision lenticule extraction surgery (SMILE) and had refractive errors ranging from -4.50 to -7.00 D (with no cylinders) and thicknesses between 90 and 140 μm. The thickness, volume and size of the donor lenticules were calibrated to match the refractive error of the recipient eye. The diameter of the donor lenticules was set to be at least 0.5 mm larger than the recipient's mesopic pupil size to prevent accommodation issues.

An 8 mm stromal pocket was created in the recipient's cornea, with a cap thickness of 130 µm and a 3.00-mm incision. Lenticules were transplanted into the pocket based on corneal topography and adjusted according to the lowest K value to correct astigmatism.

All patients were followed for 3 years. Follow-up assessments included evaluations of uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA) at 35 cm, uncorrected intermediate visual acuity (UIVA) at 70 cm, slit-lamp biomicroscopy, corneal topography, anterior segment optical coherence tomography, and pachymetry.

The UDVA improved from 0.70 ± 0.08 logMAR preoperatively to 0.04 ± 0.02 logMAR (range: 0.05–0.1) (p < 0.001). The Q value decreased from -0.50 ± 0.04 preoperatively to -0.78 ± 0.05. The UNVA at 35 cm was J6, while the postoperative UNVA at 35 cm improved to J2. Similarly, the preoperative UNVA at 70 cm was J5, and the postoperative UNVA at 70 cm improved to J3.

Myopic lenticule transplantation is a safe and effective treatment, which improves visual acuity in high hyperopic patients by changing the Q-value. This method can be an alternative to intraocular lens implantation in young patients who do not have cataracts.