Abstract
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.