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    Managing unilateral aphakia with refractive lenticule implantation

    Novel procedure corrects astigmatic error, adds tissue to cornea to correct hyperopic error

    Take-home message: Refractive lenticule implantation is providing good results as a technique for managing unilateral aphakia.

    Alexandria, Egypt—Early experience with refractive lenticule implantation (Relimp) indicates it is a promising approach for unilateral aphakia management, according to Osama I. Ibrahim, MD, PhD.

    The procedure involves small-incision lenticule extraction (SMILE; performed with the VisuMax femtosecond laser, Carl Zeiss Meditec) to correct astigmatic error followed by insertion of a fresh lenticule from a myopic donor to increase corneal thickness and correct the high hyperopic error.

    Dr. Ibrahim has been working on its development with Ibrahim Sayed-Ahmed, MD, and Moones Abdalla, MD.

    Related: New laser system simplifies astigmatism correction

    “SMILE is a new procedure originally introduced for correction of myopia, and now we are pleased to be applying it to manage different refractive errors,” said Dr. Ibrahim, professor of ophthalmology and chief of cornea and refractive surgery, Alexandria University, Alexandria, Egypt.

    “Outcomes with [refractive lenticule implantation] have been encouraging, and these patients with marked hyperopic anisometropia have been very satisfied,” he said. “They are less demanding than refractive surgery patients, and so rather than expecting good uncorrected visual acuity, they are grateful even if they need to wear glasses postoperatively to correct some residual refractive error.”

    Confronting challenges

    A number of challenges are confronted when designing a procedure that adds tissue to the cornea to correct hyperopia, Dr. Ibrahim explained.

    Related: Tips for using a single-use, preassembled silicone I/A tip system

    It needs to steepen the anterior corneal surface while avoiding the resistance of the intact Bowman’s layer and avoiding bulging of the posterior corneal surface. Proper centration and stability of the lenticule is also critical, and the procedure must allow for maintenance of corneal physiology and passage of fluids through the lenticule.

    In addition, there are the refractive issues to consider, including how to attain refractive accuracy by correcting the associated astigmatism and designing a lenticule that will correct the existing hyperopic error.

    Case example (with video)

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