{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:05:09Z","timestamp":1789556709338,"version":"build-2803163510"},"reference-count":207,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SHF-SNEC","award":["R2106\/68\/2024"],"award-info":[{"award-number":["R2106\/68\/2024"]}]},{"award":["R2106\/68\/2024"],"award-info":[{"award-number":["R2106\/68\/2024"]}],"id":[{"id":"https:\/\/ror.org\/029nvrb94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"A*STAR IAF-ICP","award":["I2401E0035"],"award-info":[{"award-number":["I2401E0035"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Stromal keratophakia was first introduced by Jose Ignacio Barraquer in the 1960s as a refractive procedure involving the implantation of a stromal lenticule into a lamellar keratectomy bed of a recipient cornea. By increasing central corneal thickness, the added lenticule induced steepening of the anterior corneal curvature, thereby increasing the refractive power. However, due to the technical limitations of the mechanical microkeratome and the use of cryolathed tissue, early clinical outcomes were often inconsistent and included risks of stromal necrosis, epithelial ingrowth, induced astigmatism, slow visual recovery, and corneal haze. Despite these limitations, Barraquer\u2019s law of thickness laid the groundwork for modern refractive surgery, including Laser-In Situ Keratomileusis (LASIK). The advancement of femtosecond laser technology has enabled the creation of precise and accurate refractive lenticules, stromal flaps, and pockets. This, in turn, has renewed interest in stromal keratophakia and facilitated the emergence of keratorefractive lenticule extraction (KLEx) procedures, through which stromal lenticules are obtained. These lenticules can be preserved and repurposed for various therapeutic and refractive applications. In this review, we provide a comprehensive overview of KLEx-derived lenticule processing and biobanking, their reuse for hyperopia and presbyopia correction, and their therapeutic potential in stromal thickness restoration, cell-based tissue engineering, drug delivery, corneal structural and macular hole repair, and glaucoma drainage tube coverage.<\/jats:p>","DOI":"10.3390\/bioengineering13091075","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:09:17Z","timestamp":1789553357000},"page":"1075","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preservation and Reuse of KLEx Lenticules: From Biobanking to Therapeutic and Refractive Innovations"],"prefix":"10.3390","volume":"13","author":[{"given":"Raimy","family":"Christodoulou","sequence":"first","affiliation":[{"name":"The Veneto Eye Bank Foundation, 30174 Venice, Italy"},{"name":"Regenerative Therapy Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3983-3328","authenticated-orcid":false,"given":"Stefano","family":"Ferrari","sequence":"additional","affiliation":[{"name":"The Veneto Eye Bank Foundation, 30174 Venice, Italy"},{"name":"Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Ponzin","sequence":"additional","affiliation":[{"name":"The Veneto Eye Bank Foundation, 30174 Venice, Italy"},{"name":"Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Nubile","sequence":"additional","affiliation":[{"name":"Ophthalmology Clinic, Department of Medicine and Aging Science, \u201cG. d\u2019Annunzio\u201d University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5105-0484","authenticated-orcid":false,"given":"Andri K.","family":"Riau","sequence":"additional","affiliation":[{"name":"Regenerative Therapy Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6362-4898","authenticated-orcid":false,"given":"Jodhbir S.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Regenerative Therapy Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore"},{"name":"Singapore National Eye Centre, Singapore 168751, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","unstructured":"Mannis, M.J., and Holland, E.J. 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