Measurement of 60 kHz Femtosecond LASIK Flaps with Anterior Segment Ocular Coherence Tomography & Ultrasonic Subtraction Pachymetry Edward E. Manche, MD.

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Financial Disclosure Calhoun Vision consultant, equity Clarity Massey Labs consultant, equity.

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Presentation transcript:

Measurement of 60 kHz Femtosecond LASIK Flaps with Anterior Segment Ocular Coherence Tomography & Ultrasonic Subtraction Pachymetry Edward E. Manche, MD Yohko Murakami, BA, MA Stanford University School of Medicine

Financial Interest Disclosure Dr. Manche is a consultant for PriaVision, Inc. Dr. Manche is an investor in Calhoun Vision, Inc. and Ophthonix, Inc.

Purpose Prospectively measure intra-operative ultrasonic subtraction pachymetry flap thickness and compare to post-operative anterior segment optical coherence tomography (OCT) flap thickness in eyes undergoing LASIK with a 60 kHz femtosecond laser

Design 32 eyes of 32 subjects Prospective study Eyes treated with IntraLase 60 kHz femtosecond laser Ultrasonic subtraction pachymetry performed intra-operatively Anterior segment ocular coherence tomography (Visante™ OCT) imaging of flap thickness performed at 3-month visit 5 measurements made of each flap OCT measurements performed by single masked observer

Design: Technique 60 kHz IntraLase femtosecond laser Programmed flap thickness: 100 um Sonogage ultrasonic pachymetery Visante OCT imaging device

Results Intra-operative Subtraction Pachymetry Post-operative Anterior Segment OCT 93.0 ± 14.3 um 100 micron programmed depth Range: 64-125 104.2 ± 5.5 um 100 micron programmed depth Range: 90-115 Updated 10/10/05cg

OCT Image of Lasik Flap

Mean Pachymetry Measurements Flap thickness (um) Patients

Mean Anterior OCT Measurements (+ Ranges) Flap thickness (um) Patients

Mean Anterior OCT vs. Pachymetry Measurements Flap thickness (um) Patients Patients

Conclusions 60 kHz femtosecond laser produces reliably uniform thin planar flaps Poor correlation between intra-operative subtraction pachymetry and post-operative anterior segment OCT Subtraction pachymetry consistently underestimated flap thickness compared to anterior segment OCT Study suggests that intraoperative subtraction pachymetry may be less accurate and more prone to measurement error than post-operative anterior segment OCT measurements

References Cheng ACK, Ho T, Lau S, Wong AL, Leung C, Lam DSC. Measurement of LASIK flap thickness with anterior segment optical coherence tomography. J. Refract Surg. 2008;24:879-884. Izquierdo L Jr, Henriquez MA, Zakrzewski PA. Detection of an abnormally thick LASIK flap with anterior segment OCT imaging prior to planned LASIK retreatment surgery. J Refract Surg. 2008 Feb;24(2):197-9. 3. Stahl JE, Durrie DS, Schwendeman FJ, Boghossian AJ. Anterior segment OCT analysis of thin IntraLase femtosecond flaps. J Refract Surg. 2007 Jun;23(6):555-8. 4. Konstantopoulos A, Hossain P, Anderson DF. Recent advances in ophthalmic anterior segment imaging: a new era for ophthalmic diagnosis? Br J Ophthalmol. 2007 Apr;91(4):551-7. Review. 5. Li Y, Netto MV, Shekhar R, Krueger RR, Huang D. A longitudinal study of LASIK flap and stromal thickness with high-speed optical coherence tomography. Ophthalmology. 2007 Jun;114(6):1124-32. Epub 2007 Feb 23. 6. Tang M, Li Y, Avila M, Huang D. Measuring total corneal power before and after laser in situ keratomileusis with high-speed optical coherence tomography. J Cataract Refract Surg. 2006 Nov;32(11):1843-50. 7. Wang J, Thomas J, Cox I. Corneal light backscatter measured by optical coherence tomography after LASIK. J Refract Surg. 2006 Jun;22(6):604-10. 8. Li Y, Shekhar R, Huang D. Corneal pachymetry mapping with high-speed optical coherence tomography. Ophthalmology. 2006 May;113(5):792-9.