Stromal Lenticule Addition Keratoplasty (SLAK) for the Management of Severe Corneal Flattening After Corneal Cross-linking.

PURPOSE: To report the first case of stromal lenticule addition keratoplasty performed for the management of severe progressive corneal flattening following corneal cross-linking (CXL). METHODS: A 63-year-old woman with keratoconus, previously treated with combined topography-guided photorefractive keratectomy and CXL (Athens protocol), presented with progressive corneal flattening and a hyperopic shift in the left eye. Corrected distance visual acuity (CDVA) was 20/50 with manifest refraction of +5.00 -1.50 × 123° and the mean keratometry was 36.20 diopters (D). Stromal lenticule addition keratoplasty was performed using a stromal lenticule obtained from a myopic small incision lenticule extraction treatment. A femtosecond laser was used to create an intrastromal pocket, and the lenticule was inserted and centered within the stromal interface. RESULTS: Postoperatively, mean keratometry increased to 41.20 D and refraction improved to +0.50 -2.00 × 110°, with 20/40 CDVA. Corneal curvature remained stable at 12 months postoperatively. CONCLUSIONS: Stromal lenticule addition keratoplasty may represent a safe and effective minimally invasive surgical option for inhibiting the progressive corneal flattening, restoring corneal curvature and correcting the excessive hyperopia in cases of severe corneal flattening following CXL.