isobeam d200 no touch for presbyopia, emmetropia presbyopia
DESCRIPTION
presbyopia treatment for emmetropia by center no touch technique to perform the surgery, and compared Kera IsoBeam D200 and Zeiss MEL80 presbyopia results performance through the wound healing period. presbyopia new method to treat emmetropic presbyopia. no touch on center cornea for emmetropia presbyopia.TRANSCRIPT
Correction of PresbyopiaCorrection of Presbyopia with Kera with Kera No-touch No-touch
techniquetechnique
Department of OphthalmologyDepartment of Ophthalmology
Chung-Ang UniversityChung-Ang University
Jae Chan Kim M.D., Ph.D.,
Refractive regression : major challenge after refractive surgery
Refractive regression : major challenge after refractive surgery
Why?Why?
Inconsistensy of wound healing after refractive surgery
Refractive regression process predominate in regions of greater tissue removal
(William J Dupps Jr, etc. Experimental eye research 2006)
Disruption of epithelium over central cornea in PRK amplifies the wound healing response and accounts for higher rates of regression and haze
(R.R Mohan, etc. Exp. Eye 2003)
Why?Why?
Inconsistensy of wound healing after refractive surgery
Refractive regression process predominate in regions of greater tissue removal
(William J Dupps Jr, etc. Experimental eye research 2006)
Disruption of epithelium over central cornea in PRK amplifies the wound healing response and accounts for higher rates of regression and haze
(R.R Mohan, etc. Exp. Eye 2003)
Refractive regression : major challenge after refractive surgeryRefractive regression : major challenge after refractive surgery
Enhanced early wound healing improves final visual outcome Enhanced early wound healing improves final visual outcome
by inhibition of regression?by inhibition of regression?
Refractive regression : major challenge after refractive surgeryRefractive regression : major challenge after refractive surgery
Enhanced early wound healing improves final visual outcome Enhanced early wound healing improves final visual outcome
by inhibition of regression?by inhibition of regression?
Preservation of central corneal epithelium Preservation of central corneal epithelium in corneal ablation surgery in corneal ablation surgery
lead to lead to
shortening of early wound healing timeshortening of early wound healing time
decrease of refractive regressiondecrease of refractive regression
Concept :
No-touch surgery in presbyopia No-touch surgery in presbyopia ??
Object: emmetropia c mild hyperopiaObject: emmetropia c mild hyperopia
effective corneal ablationeffective corneal ablation
& more accurate treatments& more accurate treatments
* Dual flying spot* Dual flying spot
homogenous energy delivery
Inventor : George huang Ph.D.
Idea from Jae Chan Kim M.D.
Woo chan Park M.D., Byung moo Min M.D.
* Small beam size :0.44mm* Small beam size :0.44mm& Random projection& Random projection
delicate ablationdelicate ablation
* Smooth ablation c no ridge* Smooth ablation c no ridge
Corneal ablation methodCorneal ablation method& Concept of early wound healing& Concept of early wound healing
Corneal ablation methodCorneal ablation method& Concept of early wound healing& Concept of early wound healing
<Emmetropia<Emmetropia –– Ablation of zone 2 only> Ablation of zone 2 only><Emmetropia<Emmetropia –– Ablation of zone 2 only> Ablation of zone 2 only>•CentCenterer - Distance vision- Distance vision
: Spherical curvature: Spherical curvature
No-touch zone(3.5~4.2mm)No-touch zone(3.5~4.2mm)
•Paracentral& PeripheralParacentral& Peripheral
- Near Vision- Near Vision
: Aspherical curvature: Aspherical curvatureDoughnut shape
1.Far 2.
Near
Ablation zone
Epithelial migrationEpithelial migration
than Peripheral epitheliumthan Peripheral epithelium
Bidirectional wound healingBidirectional wound healing
Central epithelium ; more fasterCentral epithelium ; more faster
Materials & MeasurementsMaterials & Measurements
10 patients, 12 eyes 10 patients, 12 eyes M:F = 6 : 4, 51.2 years old (43-60)M:F = 6 : 4, 51.2 years old (43-60) Emmetropia c mild hyperopia(SE ≤ ±1.25D) Emmetropia c mild hyperopia(SE ≤ ±1.25D) - mean S.E. : 0.78D- mean S.E. : 0.78D
December, 2007~ June,2008 December, 2007~ June,2008
F/U: postoperative 1, 4, 30days F/U: postoperative 1, 4, 30days MeasurementsMeasurements - - Far and near uncorrected visual acuity Far and near uncorrected visual acuity
- DOF, depth of focus- DOF, depth of focus - Topography (Humphrey® ATLAS™, Zeiss) - Topography (Humphrey® ATLAS™, Zeiss) - Aberrometer (WASCA aberrometer, Zeiss)- Aberrometer (WASCA aberrometer, Zeiss) - Contrast sensitivity (CSV-1000E, Vector vision)- Contrast sensitivity (CSV-1000E, Vector vision) - Rate of corneal wound healing - Rate of corneal wound healing
Result: Corneal epithelial wound healing rateResult: Corneal epithelial wound healing rate
Total ablationTotal ablationS.E 0.75S.E 0.75
Ablation depth 39MmAblation depth 39Mm
No-touchNo-touch
S.E 0.5S.E 0.5
Ablation depth 35MmAblation depth 35Mm
Postop.
Postop. Postop.15hrs
Postop.15hrs
POD#4
POD#4
Postop.15hrs POD#4Postop.
0
1
2
3
4
5
MEL80 no-touch
4.5days4.5days
1.3days1.3days
Comparison of corneal epithelial wound healing daysComparison of corneal epithelial wound healing days
wound healing dayswound healing days
Significant at P<0.05 at t-testSignificant at P<0.05 at t-test
*
Result: IsoBeam D200 No-touch zone (3.7~4.2mm) comparison of MEL80
Result: IsoBeam D200 No-touch zone (3.7~4.2mm) comparison of MEL80
00.20.40.60.8
11.21.4
Preop
POD#1
POD#2
POD#4
POD#3
0 .. ..
POD1Y
UCNVA(no touch) UCNVA(MEL 80)
Central zone : 3.7~4.2mm Central zone : 3.7~4.2mm
5Pts. (6eyes)5Pts. (6eyes)
emmetropia (mean S.E: 0.72)emmetropia (mean S.E: 0.72)
5.2days
?2.4days
0
0.2
0.4
0.6
0.8
1
Preop
POD#1
POD#2
POD#4
POD#3
0 .. ..
POD1Y
DUCVA(no touch) DUCVA(MEL 80)
Near visionFar vision -0.2 - 0.1
0.0
+ 0.1
+ 0.2
+ 0.4
+ 0.7
+ 1
Log MAR
?1.2days
2.3days0.5
SummarySummary
Wound healing days by IsoBeam No-touch technique was significantly more faster than that by MEL-80
Effective near & far vision by IsoBeam was significantly more faster achieved by preserving of central cornea epithelium than that by MEL-80
Expect to good final visual outcome due to faster epithelial wound healing time by preserving central cornea epithelium
Wound healing days by IsoBeam No-touch technique was significantly more faster than that by MEL-80
Effective near & far vision by IsoBeam was significantly more faster achieved by preserving of central cornea epithelium than that by MEL-80
Expect to good final visual outcome due to faster epithelial wound healing time by preserving central cornea epithelium
Reduction of corneal ablation area & preservation of central corneal epithelium Bidirectional wound healing shortening of early wound healing days decrease of refractive regression
Reduction of corneal ablation area & preservation of central corneal epithelium Bidirectional wound healing shortening of early wound healing days decrease of refractive regression
Modulation of final visual outcome by early wound healing
Modulation of final visual outcome by early wound healing