Refractive keratoplasty with intrastromal hydrogel lenticular implants.

The feasibility of using hydrogel lenticular implants of high water content to alter the anterior corneal curvature for purposes of refractive keratoplasty has been investigated in rabbits. Lenticules (6 mm in diameter) of Permalens (Perfilcon-A) were trephined from contact lens and implanted within an intralamellar pocket in the cornea. The in vitro glucose flux across the hydrogel (0.23 mm thick) was measured at 131 +/- 7 micrograms/cm(2)/hr. For clinical comparison, non-water-permeable disks of Teflon were also implanted. The Teflon implant caused an aseptic ulcer to develop anterior and central to the implant by 9 +/- 4 days. The hydrogel lenticular implant did not cause central ulceration during the 7 month postoperative follow-up. There was a thinning and eventual erosion of the stroma anterior to the edge of the hydrogel implant, 16 +/- 7 weeks. The glycogen contents of the epithelium anterior to (1) the sham operation, i.e., lamellar pocket dissection, (2) the implanted hydrogel lenticule with or without the presence of an erosion, and (3) the control corneas were statistically from the same population. Yet there was a slight dehydration of the stroma anterior to the hydrogel implant when compared to control tissue. A thin-edged implant lenticule design should overcome the stromal thinning caused by the thick-edge implants. During the short-term follow-up, the hydrogel lenticular implant proved to be successful as a refractive keratoplasty implant material.