Clinical Observation Of Lamellar Keratoplasty With Fibrin Glue-assisted Corneal Lenticules

Purposes: To observe the safety and effectiveness of lamellar keratoplasty with human corneal lenticules derived from small incision lenticule extraction(SMILE)combined with fibrin glue in the treatment of corneal dermoid tumor and corneal ulcerative perforation.Research objects and methods: Follow-up observation of 8 patients who underwent lamellar keratoplasty using SMILE-derived human corneal lenticules as corneal repair material in our hospital from May 2020 to March 2021,including3 cases of corneal dermoid tumor,4 cases of corneal ulcerative perforation,1 case of deep corneal ulcer.Before the operation,all patients,except 2 patients who did not cooperate with the visual inspection due to their young age,had visual inspection,slit lamp,and anterior segment photographic inspection.All patients with corneal dermoid tumors were examined by anterior segment optical coherence tomography(AS-OCT)to determine the depth of the tumor invading the cornea,except for one patient who did not cooperate.All patients with corneal ulcer perforation used a ruler to measure the size of the corneal perforation.All patients underwent lamellar keratoplasty with the help of fibrin glue using SMILE-derived human corneal lenticules as the corneal graft material.Among them,2 patients with corneal ulcerative perforation underwent lamellar keratoplasty with 2 superimposed and bonded corneal lenticules.Tacrolimus eye drops was used to prevent rejection in 1 week after surgery,and the total course of treatment was 2 months.Follow-up observations were carried out at 1 week,1month,2 months,and 3 months after surgery.All patients,except for one child who did not cooperate with visual acuity,AS-OCT,anterior segment photographic examination,and one child who did not cooperate with visual examination,the rest all performed visual acuity,slit lamp,anterior segment photography and ASOCT examination.Results: 3 months after the operation,the cornea of 8 patients healed and the cornea was completely epithelialized.The corneal lenticules grafts were in place in 6 of the 8 patients,and the corneal lenticules graft of 1 patient with perforated corneal ulcer was thinner than before,the corneal lenticules grafts of 2 patients dissolved,including 1 patient with perforated corneal ulcer and 1 case of deep corneal ulcer.These 3 cases of corneal lenticules graft thinning or dissolving only used a corneal lenticule.Among the 6 patients who cooperated with the visual acuity examination,the visual acuity of 5 cases improved compared with that before the operation,and the visual acuity of 1 case was reduced to no light perception due to absolute glaucoma 6 years ago,and the visual acuity remained unchanged after the operation.No rejection occurred in all eyes.Conclusion: In short-term observation,human corneal lenticules derived from SMILE combined with fibrin glue for lamellar keratoplasty is safe and effective for the treatment of corneal dermoid tumor and corneal ulcerative perforation.This surgical method has potential clinical application value.For patients with corneal ulcerative perforation,the superposition and bonding of two corneal lenticules may be more effective in maintaining the long-term survival of corneal grafts than using one alone.