Tectonic keratoplasty using small incision lenticule extraction-extracted intrastromal lenticule for corneal lesions

Objective This study investigated an alternative approach for obtaining donor corneas for keratoplasty that can be used in nations with high corneal demand and high costs for treatment of non-healing ulcers or lesions. Methods Eighteen patients (18 eyes) who underwent tectonic keratoplasty using small incision refractive lenticule extraction (SMILE)-extracted lenticule were included. Data were recorded regarding age, corneal status, corneal lesion location and size, preoperative and postoperative visual acuity, lenticule layer, and additional medical history. Results Corneal thinning and corneal perforation in 13 and 5 patients, respectively, were treated with tectonic keratoplasty using SMILE-extracted lenticule. After tectonic keratoplasty, globe integrity was maintained in 16 of the 18 patients. The mean decimal visual acuity improved from 0.2555±0.3326 preoperatively to 0.3303±0.3487 at the final follow-up. Visual acuity improvement was greater in patients with corneal perforation than in patients with corneal thinning. In addition, visual acuity was most improved in patients with infratemporal lesions. Conclusion Tectonic keratoplasty using SMILE-extracted lenticule is a comparatively safe, effective, and reliable alternative approach for the treatment of corneal lesions.