post-lasik corneal ectasia

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Presentation transcript:

post-lasik corneal ectasia Femtosecond laser assisted intrastromal corneal ring segment implantation for post-lasik corneal ectasia Dominique PIETRINI, MD Tony GUEDJ,OD,ORTH Clinique de la Vision, Paris. dpietrini@club.fr Financial disclosure: Dr D. Pietrini is a paid consultant for Mediphacos 1

Materials and Methods 13 eyes with post lasik ectasia, follow up 6 months to 4 years. Mean age 38 years Initial surgery Microkeratome 80% Femtosecond 20% Time between lasik ands ICRS 3 years Form frust keratoconus in 8 cases / Insufficient stromal bed 2 cases / unkown etiology or association remaining cases ICRS femtosecond implantation all cases 3 eyes implanted with Intacs (Addition technology) 10 eyes implanted with Kerarings (Mediphacos) Interest of OCT for corneal evaluation Mean flap thickness 148µm +/- 16.5µm (120/200) Mean residual stromal bed 294µm +/- 55.1µm (210/400)

Evolution of spherical equivalent and refractive cylinder

Evolution of uncorrected and best corrected visual acuity UCVA Mean gain 5 lines BCVA Mean gain 3 lines p<0.05 N=13

Keratometric measurements Orbscan readings Keratometry Mean K reduced by 3D Kmax reduced by 4.6D p<0.05 N=13

Corneal astigmatism N=13

High Order Aberration N=2 HOA Rms showed a reduction of 59% after 2years for Two eyes Vertical Coma showed a reduction of 69% after 2years for Two Eyes H.Coma N=2

Case Report M. A.B,Man, 33 years old Post lasik ectasia: Marginal pellucid corneal dystrophy LEFT EYE PRE OP 1 Week after KERARING IMPLANTATION KERATOMETRY: 38.4D /43.7D 3° 38.2D/40.9D 175° ASTIGMATISM: 5.3D 2.7D PACHYMETRY: 401µm 414µm UCVA: 0.5 Log mar (3/10) 0.0 Log mar (9/10) BCVA: 0.0 Log mar (10/10F) -0.1 Log mar (12/10) REFRACTION: +1,75 (-4,50)85° +2.50 (-2.50)85°

Post lasik ectasia on marginal pellucid corneal dystrophy OCT Visante Corneal Flap OCT PRE OP : Size of corneal flap Post lasik ectasia on marginal pellucid corneal dystrophy Corneal Flap KERARING OCT POST OP KERARING: Depth: 310µm Corneal Flap: 120µm

Marginal pellucid corneal dystrophy POST LASIK ECTASIA POST KERARING Orbscan Dual POST LASIK ECTASIA : Marginal pellucid corneal dystrophy Corneal Flap OCT PRE OP POST LASIK ECTASIA Corneal Flap PRE OP REFRACTION: +1,75 (-4,50)85° UCVA:0.5 Log mar BCVA:0.0 Log mar POST OP 1 Week REFRACTION: +2.50 (-2.50)85° UCVA :0.0 Log mar BCVA:-0.1 Log mar KERARING OCT POST OP POST LASIK ECTASIA POST KERARING DEPTH: 330µm Corneal Flap: 120µm

CONCLUSION Femtosecond intrastromal corneal ring segment implantation is an affective and safe method for the management of post lasik ectasia. Restores good level of visual acuity. Objective improvement of visual acuity. BCVA improved by 3 lines. Corneal astigmatism reduced by 2,6 d. Maximal keratometry reduced by 4.6 diopters. Reduce Hoa Rms. High patient satisfaction. Low complications rate. Reversible.

Dominique Pietrini, MD, is a member of the active staff of the Clinique de la Vision, Paris France. Dr. Dominique Pietrini states that he is a paid consultant to Mediphacos. Dr. Pietrini can be reached at +33 145 630 668 dpietrini@club.fr www.cliniquevsion .com

Tony Guedj, OD,ORT Clinique de la vision, Paris France. Tony Guedj can be reached at +33 145 630 668 tony.guedj@yahoo.fr