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  • PEARL for Presbyopia: Early Results


    Soosan Jacob, FRCS, discussed 6-month outcomes of a novel technique she has developed to improve near vision in presbyopia. The procedure, which she calls PEARL (for presbyopic allogenic refractive lenticule), creates an allogenic corneal inlay from tissue removed during small-incision lenticule extraction (SMILE) surgery, explained Dr. Jacob, speaking on Saturday at the Cornea Subspecialty Day meeting.

    Rationale. Although corneal inlays have become a popular option for selected presbyopic patients, “standard corneal inlays use synthetic material and may be associated with complications, such as an inflammatory response,” Dr. Jacob said. In contrast, use of a biocompatible allogenic inlay bypasses those problems.

    Procedure. In a pilot study1 conducted in Chennai, India, Dr. Jacob used the femtosecond laser to create a corneal lenticule during SMILE surgery in 4 patients (4 donor eyes). The lenticule was kept in solution while Dr. Jacob created a pocket in the recipient cornea with the femtosecond laser. The center of the PEARL inlay was marked; it was then implanted in the patient’s nondominant eye to lie over the coaxially sighted light reflex.

    Results. At 6 months, “we observed between a 3- and 5-line improvement [in near vision] in all eyes,” Dr. Jacob said. “There was no regression in near, intermediate, or distance visual acuity, no complaints or dysphotopsias, and no troublesome night glare.” All lenticules remained well centered during follow-up, and no complications were noted. In addition, reading speed markedly improved, and all patients reported satisfaction with the procedure.

    Looking ahead. The allogenic inlay “has good integration into the cornea—and it is reversible and adjustable if required,” Dr. Jacob said.  

    “This is definitely a feasible technique,” she added, “and we are now onto a longer-term study.”—Jean Shaw

     1 Jacob S et al. J Refract Surg. 2017;33(4):224-229.

     Financial disclosures. None.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.