Abstract: Objective To observe the clinical efficacy of the small incision lenticule extraction (SMILE)-derived lenticule for the viral keratitis with perforation. Design Retrospective case series. Participants 19 patients (19 eyes) of viral keratitis with perforation in the Affiliated Eye Hospital of Nanjing Medical University from April 2015 to December 2018. Methods Debride the gap to form a bowl-shaped planting bed. Selecting the lenticule with a central thickness more than 100 microns, and drill the lenticule with a drill ring to make it 1 mm larger than the wound surface under the microscope. The lenticule is fixed on the surface of the implantation bed with 10-0 nylon wire, filling the implants according to the depth of the implantation bed until the corneal surface is slightly elevated, and wearing the bandage len at last. The best postoperative corrected visual acuity, the condition of gap repairing and graft attachment was observed in 6 months after the surgery. Main Outcome Measures The best postoperative corrected visual acuity, the condition of gap repairing and graft attachment. Results All perforations were successfully repaired in 19 eyes. The best corrected visual acuity was improved in 12 eyes, including 8 eyes with 0.02~0.15, and 4 eyes with 0.2~0.4. During the postoperative follow-up for 6 months, no recurrence of viral keratitis was observed in 19 eyes, no other bacterial infection was found, and all eye grafts were attached well. Conclusion SMILE-derived lenticule is a safe, effective implant for treating viral keratitis with perforation.

Key words: viral keratitis, corneal perforation, small incision lenticule extraction, lenticule