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Femtosecond Laser-Assisted Intracorneal Biopolymer Insertion for the Symptomatic Treatment of Bullous Keratopathy

Kymionis, George D. MD, PhD; Diakonis, Vasilios F. MD, PhD; Kankariya, Vardhaman P. MD; Plaka, Argyro D. MD, MSc; Panagopoulou, Sofia I. PhD; Kontadakis, George A. MD, MSc; Grentzelos, Michael A. MD; Tsilimbaris, Miltiades K. MD, PhD; Pallikaris, Ioannis G. MD, PhD

doi: 10.1097/ICO.0000000000000081

Purpose: To describe a new minimally invasive surgical technique for the symptomatic management of bullous keratopathy in blind eyes.

Methods: Four patients with severe corneal edema due to endothelial decompensation and no visual function in the affected eye presented for the relief of their ocular symptoms (pain and tearing). Femtosecond laser technology was used to create a deep corneal pocket into which silicone oil was inserted.

Results: After the procedure, all patients demonstrated immediate relief of their symptoms, along with restoration of a normal corneal surface 7 days after the procedure (no bullae and no epithelial defects). All patients remained free of symptoms during the entire follow-up period (from 24 to 31 months). Anterior to the inserted implant, the corneal lamellae remained compact, transparent, and without bullae; whereas the posterior corneal stroma under the implant was edematous. No intraoperative or postoperative complications were noted.

Conclusions: Intracorneal insertion of silicone oil is a feasible new technique for the symptomatic treatment of bullous keratopathy in blind eyes.

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*Vardinoyiannion Eye Institute of Crete (VEIC), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece; and

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL.

Reprints: George D. Kymionis, Vardinoyiannion Eye Institute of Crete (VEIC), Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received November 29, 2013

Accepted January 05, 2014

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