Refractive Lenticule Implantation for Correction of Ametropia: Case Reports and Literature Review

Abstract

The ReLEx® technique allows correction of refractive errors through the creation and extraction of refractive stromal lenticules. Contrary to excimer laser corneal refractive procedures, where the stromal tissue is photoablated, the extracted lenticules obtained with ReLEx® can be preserved. Recent studies and case reports have described autologous re-implantation and allogeneic implantation of refractive lenticules into femtosecond-laser created stromal pockets in order to reverse the refractive outcome of a myopic corneal refractive procedure, correct hyperopia, aphakia, presbyopia and treat keratoconus. The use of stromal lenticules has also been described for therapeutic purposes, with an allogenic lenticule being transplanted under a LASIK flap in order to restore corneal volume and reduce the refractive error in a case of excessive stromal tissue removal after LASIK. This review summarises the results of the latest case reports and studies that describe the implantation of cryopreserved or fresh refractive stromal lenticules and discusses the feasibility, safety and refractive outcomes of the procedure, on the basis of published literature as well as our own experience.

Zusammenfassung

Die ReLEx®-Technik ermöglicht die Korrektur von Fehlsichtigkeiten durch das Erzeugen und die Entfernung eines refraktiven Lentikels aus dem Hornhautstroma. Im Gegensatz zu keratorefraktiven Excimer-Laser-Chirurgie, wobei das stromale Gewebe unwiderruflich abgetragen wird, können die refraktiven Lentikel nach ReLEx erhalten werden. Jüngste Studien und Fallberichte beschrieben die autologe Re-Implantation und allogene Implantation von refraktiven Lentikeln in durch den Femtosekundenlaser erzeugten Stromataschen, um das refraktive Ergebnis einer keratorefraktiven Chirurgie umzukehren, die Hyperopie, Aphakie und Presbyopie zu korrigieren und den Keratokonus zu behandeln. Die Verwendung von allogenen stromalen Lentikeln wurde auch für therapeutische Zwecke mittels einer Transplantation unter einen durch Femto-LASIK erzeugten Flap, beschrieben, um das Hornhautvolumen, im Fall einer übermäßigen Stromagewebeentfernung nach LASIK, wiederherzustellen und den refraktiven Fehler zu reduzieren. Diese Übersicht fasst die Ergebnisse der neuesten Fallberichte und Studien zusammen, die sich mit der Implantation von kryokonservierten oder frischen refraktiven Lentikeln beschäftigen, und bewertet die Wirksamkeit, Sicherheit und die refraktiven Ergebnisse des Verfahrens auf der Grundlage veröffentlichter Literatur sowie eigener Erfahrung.

Key words

ReLEx - refractive lenticule - implantation - ametropia

Schlüsselwörter

ReLEx - refraktiver Lentikel - Implantation - Ametropien

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