Temporary KLEx Lenticule-Assisted Corneal Cross-linking in Thin-Cornea Keratoconus: A Case Series

Purpose: To evaluate the feasibility, safety, and efficacy of corneal cross-linking (CXL) assisted by a temporary stromal lenticule onlay in patients with progressive keratoconus and thin corneas. Methods: This retrospective single-center case series included 14 eyes of 14 patients with progressive keratoconus and a minimum corneal thickness of less than 400 µm. A stromal lenticule obtained from keratorefractive lenticule extraction (KLEx) refractive surgery was temporarily placed on the de-epithelialized cornea to increase corneal thickness before accelerated epithelium-off CXL (9 mW/cm 2 for 10 minutes; total dose 5.4 J/cm 2 ). The lenticule thickness ranged from 70 to 140 µm and was removed after irradiation. Patients were observed for 12 months. Outcome measures included maximum keratometry (Kmax), corrected distance visual acuity (CDVA), endothelial cell density, and visualization of the stromal demarcation line on anterior segment optical coherence tomography. Results: Mean preoperative Kmax was 73.70 ± 12.80 diopters (D) and mean minimum corneal thickness was 375.0 ± 18.4 µm. The addition of the stromal lenticule increased mean corrected corneal thickness to 479.5 ± 29.1 µm. At 12 months, mean Kmax decreased by 1.10 D, with disease stabilization in 13 of 14 eyes. No significant change in CDVA or endothelial cell density was observed. A stromal demarcation line was identified in 85.7% of eyes at a mean depth of 291.8 ± 42.8 µm. Conclusions: Temporary stromal lenticule onlay–assisted CXL appears to be a feasible and promising approach for progressive keratoconus in thin corneas, with encouraging short-term stabilization results requiring confirmation in larger studies.