Epikeratophakia using small-incision lenticule extraction lenticule addition combined with corneal crosslinking for keratoconus

An 18-year-old man with keratoconus had epikeratophakia using small-incision lenticule extraction lenticule addition in the left eye, which had a minimum corneal thickness of 356 μm. Accelerated (45 mW/cm2) transepithelial corneal crosslinking was performed 1 month later. The patient was followed for 3 years postoperatively. Examinations included anterior segment optical coherence tomography (AS-OCT), uncorrected (UDVA) and corrected (CDVA) distance visual acuities, subjective refraction, and topographic changes. The UDVA in the left eye improved from 20/200 preoperatively to 20/63 postoperatively, and the CDVA improved from 20/125 to 20/40. The manifest refraction was −1.50 −5.25 × 110. Corneal topography showed that lenticule implantation increased the thickness of the central and midperipheral cornea, with a minimum corneal thickness of 470 μm. The mean keratometry and greatest posterior elevation values were stable from 3 months postoperatively forward. On AS-OCT, the lenticule remained transparent and was attached smoothly with a visible demarcation line.