Sutureless Epikeratophakia After Small Incision Lenticule Extraction: A Case Report to Correct Corneal Deformity.
Ivey Thornton, Jiawei Wu, Ronald R Krueger et al.
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Case in brief
An 18-year-old woman developed severe corneal thinning, with a residual stromal bed of 176 μm, and irregular hyperopic astigmatism in her left eye after a femtosecond laser malfunction during keratorefractive lenticule extraction. Customized transepithelial phototherapeutic keratectomy (80 μm depth, 7.2 mm diameter) prepared a more regular stromal bed, onto which an allogeneic donor lenticule was placed without sutures. The graft integrated, and corneal topography showed surface regularization. Topography-guided transepithelial photorefractive keratectomy was later used to refine residual irregularity and refraction; final uncorrected distance visual acuity was 20/16.
What made this case unusual
The case used a donor lenticule as a sutureless epikeratophakia overlay to address severe thinning and irregularity after a laser malfunction during lenticule extraction.
Diagnostic / clinical pearl
After a complicated lenticule-extraction procedure, assess both stromal thickness and corneal irregularity; this case illustrates a reconstructive approach combining customized surface ablation with a sutureless donor-lenticule overlay.