Reversible femtosecond laser-assisted myopia correction: a non-human primate study of lenticule re-implantation after refractive lenticule extraction

PLoS One. 2013 Jun 24;8(6):e67058. doi: 10.1371/journal.pone.0067058. Print 2013.

Abstract

LASIK (laser-assisted in situ keratomileusis) is a common laser refractive procedure for myopia and astigmatism, involving permanent removal of anterior corneal stromal tissue by excimer ablation beneath a hinged flap. Correction of refractive error is achieved by the resulting change in the curvature of the cornea and is limited by central corneal thickness, as a thin residual stromal bed may result in biomechanical instability of the cornea. A recently developed alternative to LASIK called Refractive Lenticule Extraction (ReLEx) utilizes solely a femtosecond laser (FSL) to incise an intrastromal refractive lenticule (RL), which results in reshaping the corneal curvature and correcting the myopia and/or astigmatism. As the RL is extracted intact in the ReLEx, we hypothesized that it could be cryopreserved and re-implanted at a later date to restore corneal stromal volume, in the event of keratectasia, making ReLEx a potentially reversible procedure, unlike LASIK. In this study, we re-implanted cryopreserved RLs in a non-human primate model of ReLEx. Mild intrastromal haze, noted during the first 2 weeks after re-implantation, subsided after 8 weeks. Refractive parameters including corneal thickness, anterior curvature and refractive error indices were restored to near pre-operative values after the re-implantation. Immunohistochemistry revealed no myofibroblast formation or abnormal collagen type I expression after 8 weeks, and a significant attenuation of fibronectin and tenascin expression from week 8 to 16 after re-implantation. In addition, keratocyte re-population could be found along the implanted RL interfaces. Our findings suggest that RL cryopreservation and re-implantation after ReLEx appears feasible, suggesting the possibility of potential reversibility of the procedure, and possible future uses of RLs in treating other corneal disorders and refractive errors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Actins / metabolism
  • Animals
  • CD18 Antigens / metabolism
  • Collagen Type I / metabolism
  • Corneal Stroma / pathology
  • Corneal Stroma / surgery*
  • Eye, Artificial*
  • Fibronectins / metabolism
  • Humans
  • Immunohistochemistry
  • In Situ Nick-End Labeling
  • Ki-67 Antigen / metabolism
  • Lasers, Excimer*
  • Macaca / surgery*
  • Myopia / surgery*
  • Prosthesis Implantation*
  • Refractometry*
  • Tenascin / metabolism
  • Time Factors
  • Tomography, Optical Coherence

Substances

  • Actins
  • CD18 Antigens
  • Collagen Type I
  • Fibronectins
  • Ki-67 Antigen
  • Tenascin

Grants and funding

Funding came from a National Research Foundation of Singapore-Funded Translational and Clinical Research Programme Grant (NMRC/TCR/002-SERI/2008) and Centre Grant (NMRC/CG/SERI/2010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.