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Impressum
Laser Assisted Intrastromal Keratophakia (LAIK) - A Case Report
1Jankov M., 2Mrochen M. C., 3Seiler T.,
3Augenklinik, UniversitätsSpital Zürich, Schweiz; 1Departamento de Oftalmologia, Santa Casa de Sao Paulo, Brasil; 2ETH, Zürich, Schweiz
Objective: The feasibility of correcting high hyperopia by means
of intrastromal implantation of a laser shaped corneal lenticule.
Methods: A 42-year-old patient with high hyperopia and an irregular
astigmatism resulting from earlier LASIK treatments and lamellar keratoplasty,
underwent the laser assisted intrastromal keratophakia. Preoperative data:
unaided visual acuity (UVA) 0.06, best spectacle-corrected visual acuity
(BSCVA) 0.2 with Sph: +8.00 D Cyl: -1.00 D @ 130o. Computerised topography
showed highly irregular cornea with the central thickness of 398 µm.
Lenticule preparation: mechanical de-epithelisation, keratectomy with
a microkeratome (Berlin®, Schwind, Kleinostheim, Germany), special
user-designed software combining PRK treatment for Sph: + 8.00 D, OZ:
7.0 mm by an excimer laser (Allegretto®, WaveLight Laser Technologie
AG, Erlangen, Germany) and a circumferential cut with internal diameter
of 6.5 mm. Implantation: regular LASIK enhancement technique to re-lift
the flap. After having positioned the lenticule onto the stromal bed stretching
and fine adjustments of the flap took place, and a soft bandage contact
lens has been placed.
Results: The operation went uneventful and so was the early postoperative
follow-up. Small peripheral erosion of 0.7 mm corresponding to 'short
flap' phenomenon as well as flap and lenticule oedema were present on
1st and 2nd day, but not 7 days postoperatively. UVA increased from 0.06
to 0.16, BSCVA from 0.2 to 0.3 with Sph: +1.25 D Cyl: -1.25 D @ 130o.
Central corneal thickness was 610 µm. Computerised topography showed
a more regular cornea with increased curvature values in all meridians.
Conclusion: LAIK might open a new opportunity for correcting high
hyperopic and irregular astigmatic eyes with a thin corneal bed, usually
after previous LASIK complications. The lenticule preparation and the
implantation seems to be a simple, precise and potentially reversible
technique, however, clinical evaluation of this new technique is required
for determination of possible complications, predictability and stability.