Hybrid intrastromal femtokeratoplasty with transplantation of a biosynthetic complex in keratoconus

Relevance Intrastromal keratoplasty is a modern approach to the surgical treatment of keratoconus (KC) [1–3]. This technique makes it possible to stabilize the progression of the disease and correct induced refractive errors by remodeling the cornea to improve its optical properties. The use of femtosecond laser-assisted banded lamellar optical keratoplasty (BLOK) has demonstrated its efficacy and safety in stopping the progression of keratectasia and reducing corneal curvature in patients with KC, but there was persistence of irregular astigmatism [4, 5]. A hybrid approach to the treatment of KC, which is a modification of BLOK that combines the use of an allograft and intrastromal corneal segments (ICS), called a biosynthetic complex (BSC), is aimed at reducing residual astigmatism and improving the regularity of the corneal surface. Clinical case. Patient N., 38 years old. Was observed with a diagnosis of stage III keratoconus on OU. Due to deterioration of visual acuity (VA), lack of VA improvement with the use of spectacle correction and discomfort arising when trying to wear hard contact lenses, it was decided to perform hybrid intrastromal femtokeratoplasty with BSC transplantation on the worse-seeing left eye in order to further reduce the irregularity of the central zone of the cornea with a decrease in the magnitude of ametropia. The dynamics of the parameters before and 1 month after the operation are presented in the table. The hybrid approach we proposed in the treatment of progressive CC leads to an increase in corneal rigidity, allowing to stabilize the keratectasia process, on the one hand, and to reduce keratometric parameters, including irregular astigmatism, which allows to achieve high VA, on the other hand. In progressive CC, the use of BSC is a promising treatment method. Key words: progressive keratoconus; interlamellar keratoplasty; allograft; intrastromal corneal segment; femtosecond laser; bandage therapeutic optical keratoplasty; biosynthetic complex; irregular corneal astigmatism