In vivo confocal microscopic investigation of the cornea after autologous implantation of lenticules obtained through small incision lenticule extraction for treatment of hyperopia.

PURPOSE: To investigate re-innervation in the implanted lenticule, as well as changes to the cornea, after correcting hyperopia with an autologous implantation of a lenticule obtained through small incision lenticule extraction (SMILE).

METHODS: This study retrospectively analysed re-innervation in the implanted lenticule, as well as microscopic morphological changes in the corneal architecture of the recipient cornea in five patients (with myopia in one eye and hyperopia in the contralateral eye) who received SMILE in the myopic eye and femtosecond laser in situ keratomileusis (FS-LASIK) combined with lenticule implantation in the contralateral hyperopic eye. Re-innervation in the implanted lenticule, as well as microscopic morphological changes in corneal architecture, were evaluated by in vivo confocal microscopy.

RESULTS: One patient was examined at postoperative week six, two were examined at postoperative month two, one was examined at postoperative month nine, and one was examined at postoperative month 12. Partial subbasal nerve fibre regeneration was detected in two patients (Case 4 who was examined at postoperative month nine and Case 5 who was examined at postoperative month 12). Regenerated and branched nerve fibres were detected in the implanted lenticule in Case 5 who was examined at postoperative month 12. Both the anterior and posterior interfaces showed an absence or decrease of keratocytes and the presence of small particles of various brightnesses. Keratocytes in the implanted lenticule presented abnormal morphology in size and shape after surgery in all treated eyes, but showed partial morphological recovery in two patients (Case 4 who was examined at postoperative month nine and Case 5 who was examined at postoperative month 12).

CONCLUSIONS: These preliminary findings suggest that nerve fibres will regenerate into the implanted lenticule after autologous lenticule implantation. Keratocytes in lenticules demonstrated a gradual return to a normal morphology.