Purpose To report a rare case of central toxic keratopathy after small incision lenticule extraction surgery (SMILE). Case report A 38-year-old female presented with visual loss 10 days after undergoing SMILE. Subsequently, transparent band keratopathy was protruded in the left cornea and corneal cap opacity was increased, which was accompanied by hyperopic shift and corneal thinning. The patient's condition rapidly improved with the administration of prednisolone acetate and autologous serum, with significant resolution of the transparent band keratopathy within 5 weeks of treatment initiation and subsequent complete visual recovery. Conclusions Central toxic keratopathy is a severe complication after undergoing SMILE, which might be effectively treated using with steroids and autologous serum.
Background. Corneal collagen cross-linking (CXL) therapy, a method that uses a combination of riboflavin and ultraviolet-A light (UVA), can promote the formation of covalent cross-linking of amino acid residues of corneal collagen and enhance the hardness of the cornea. In this study, we explored the effects of corneal stromal lens collagen cross-linking regraft on corneal biomechanics. Methods. A total of 15 New Zealand white rabbits were divided into 3 groups: normal control group (group A), SMILE + uncross-linked lens implantation group (Group B), and SMILE + cross-linking lens implantation group (group C). The design parameters of SMILE surgery were as follows: the corneal cap was 120 um thick, the lens diameter was 6.5 mm, and the diopter was -6.0D. Riboflavin and ultraviolet-A (UVA) were used as corneal stromal lens CXL, which was implanted into the allogeneic rabbit corneal stromal bag 24 hours after the operation. Postoperative corneal thickness (CCT), refraction, AS-OCT, and corneal biomechanics were performed before and then at 1 and 3 months after the operation. Results. All corneas appeared transparent and smooth 3 months after surgery. The corneal thicknesses of both group B and group C were lower than those before the operation. The corrected refraction of group B and group C after lens implantation was also lower than the expected corrected power; there was no significant difference between the two groups ( P > 0.05 ). AS-OCT results showed an uneven surface and thickness of the corneal stromal lens in two eyes of group B. Moreover, corneal elastic deformation increased with intraocular pressure in each group; displacement from large to small was group B > group C and > group A. The creep from large to small was group B > group C > group A. The fiberboard layers of groups B and C were disordered, and there were a few autophagosomes in the fibroblasts of group B by transmission electron microscopy (TEM). Conclusions. Allograft graft of corneal stromal lens collagen cross-linked can significantly increase the biomechanical properties of the cornea.
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