There are two possible surgical alternatives to the lenticule implantation procedure for the correction of high hyperopia. One is termed Lenticule Intrastromal Keratoplasty (LIKE), coined by Theo Seiler, in which a flap is created to visualize the stromal bed and a lenticule is centrally positioned on the optical axis. The second is a slight modification of this method, which we term small-incision lenticular intrastromal keratoplasty (sLIKE). In this method, the lenticule is inserted into a stromal pocket via small-incisions without the creation of a flap, similar to SMILE.
We first begin the video by demonstrating a myopic (-6D) lenticule extraction via a standard small-incision lenticule extraction (SMILE) followed by implantation of the harvested lenticule into a small pocket via sLIKE.
sLIKE Surgical Technique: The first step includes marking of the pupillary center (not shown in the video). Using WaveLight FS200 Femtosecond Laser, a 9mm diameter pocket was created at the depth of 120 µm with 5 mm incision at 0º Meridian. The incision was opened with a spatula and the plane of the pocket was dissected. A dried lenticule is then placed on the corneal surface and marked with an “S” to indicate anterior orientation. The lenticule was then soaked in 0.06% Trypan Blue Ophthalmic solution (VisionBlue 3214 VN Zuidland, The Netherlands) for 45 seconds, and subsequently, irrigated with saline to rid any excess staining. The staining will help facilitate easier insertion of the lenticule. The lenticule is then inserted into the pocket using a special forceps delivery (similar to KAMRA corneal inlay insertion forcep) while maintaining correct orientation via the “S” mark. Under the demarcated pupillary center, the lenticule is then aligned and spread out inside the stromal pocket.
corneal lenticule • Hyperopia • sLIKE, Small-incision Lenticular Intrastromal Keratoplasty • Small Incision Lenticule Extraction, SMILE • Wavelight FS200 Femtosecond Laser
In This Video