Toric Lenticule Implantation for Correction of Hyperopia and Astigmatism Following Small Incision Lenticule Intrastromal Keratoplasty With the Triple Marking Method

Abstract

PURPOSE: To describe the first use of toric lenticule implantation with the triple marking method to correct hyperopia and hyperopic astigmatism following small incision lenticule intrastromal keratoplasty (SMI-LIKE). METHODS: Five eyes of four patients with hyperopia (+5.25 to +9.50 diopters sphere) were included. Allogenic toric lenticules extracted using myopic small incision lenticule extraction were implanted and rotated into a femtosecond laser–created stromal pocket in hyperopic recipients with triple marking. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, corneal topography, and Fourier-domain optical coherence tomography images were examined 6 months postoperatively. RESULTS: Six months after surgery, 4 eyes (80%) gained two or more lines of UDVA, and 1 eye (20%) had unchanged UDVA. No eyes lost any lines of CDVA. The spherical equivalent decreased from +6.23 ± 1.34 diopters (D) preoperatively to −0.35 ± 0.27 D postoperatively. The mean refractive astigmatism also decreased significantly from −2.15 ± 1.10 D preoperatively to −0.70 ± 0.21 D postoperatively. Of 5 treated eyes, 2 (40%) had postoperative astigmatism within ±0.50 diopters cylinder and 5 (100%) within ±1.00 diopters cylinder. Corneal topography showed a significant increase in the anterior surface keratometry value, whereas corneal astigmatism decreased from 2.62 ± 1.55 to 1.10 ± 0.44 D. Vector analyses suggested good predictability and efficacy for astigmatism correction. CONCLUSIONS: Implantation of toric lenticules following SMI-LIKE with the triple marking method is a feasible alternative for correcting hyperopia and hyperopic astigmatism, and the short-term results seem safe and stable. [ J Refract Surg . 2022;38(2):82–88.]