Sutureless Epikeratophakia After Small Incision Lenticule Extraction: A Case Report to Correct Corneal Deformity.

Purpose

To describe a novel therapeutic approach using transepithelial phototherapeutic keratectomy (t-PTK) combined with sutureless epikeratophakia to manage a severe corneal deformity and irregular hyperopic astigmatism caused by a femtosecond laser malfunction during keratorefractive lenticule extraction (KLEx).

Methods

An 18-year-old woman presented with severe corneal thinning (residual stromal bed of 176 μm) and irregular astigmatism in the left eye following complicated KLEx. Management involved customized t-PTK (80 μm depth, 7.2 mm diameter) to prepare a regular stromal bed, followed by sutureless overlay of an allogeneic donor lenticule harvested from a KLEx. Topography-guided transepithelial photorefractive keratectomy (t-PRK) was performed 5 months postoperatively to refine the residual corneal irregularity and refractive outcome.

Results

The graft integrated successfully without sutures. Topography confirmed significant regularization of the corneal surface, and the patient achieved an uncorrected distance visual acuity of 20/16 at the final follow-up.

Conclusions

Sutureless epikeratophakia combined with customized surface ablation provides a safe, effective alternative for reconstructing irregular, severely thinned corneas following surgical complications.