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The authors have no financial interest to disclosure Clinical Outcomes of Patients With Small-Aperture Corneal Inlay for the Correction of Presbyopia Randall Ulate, MD (Presenting Author); Noa Avni-Zauberman, MD, MHA; Yakov Goldich, MD; Clara C. Chan, MD, FRCSC; Neera Singal, MD, FRCSC; Mauricio A. Perez, MD; David S. Rootman, MD, FRCSC The authors have no financial interest to disclosure

Purpose To report the results, safety, efficacy and complications of a small aperture corneal inlay (KAMRA, AcuFocus Inc) to improve near and intermediate vision in emmetropic, hyperopic or myopic presbyopes. Methods Design: Retrospective, nonrandomized, consecutive case series. The corneal inlay was implanted in the non-dominant eye of emmetropic patients, or those undergoing bilateral laser vision correction. Refraction, uncorrected near (UCNVA), intermediate (UCIVA), and distance (UCDVA) visual acuities; best corrected distance visual acuity (BCDVA), subjective patient satisfaction and symptoms, and operative and postoperative complications were evaluated.

Results The study enrolled 69 eyes of 69 patients with a mean age of 52.09 years, SD: 4.09. In the treated eyes, 26 were emmetropic (38%), 28 were myopic (40%) and 15 were hyperopic (22%), these two last groups were treated with LASIK, aiming for a postoperative refraction between -0.75 to 0. The average postoperative follow up period was 7.7 months, SD: 4.7. The mean logMAR uncorrected distance visual acuity in the eye with the inlay improved from an average of 0.51 preoperative to 0.20 in the last postoperative evaluation (Decimal: from 0.56 to 0.68), P= 0.85. The Spherical equivalent decreased from -1.022 to -0.498, P: 0.09. The mean Jaeger uncorrected near visual acuity improved from 7.19 to 1.42, P <0.001, and the intermediate visual acuity improved from 7.63 to 1.67, P <0.001. 17 eyes of 69 (24.5%) required a surgical re-intervention, 10 eyes (14.5%) were treated with LASER enhancement to correct residual refractive errors, 4 with residual myopia and 6 with residual hyperopia , 4 eyes (5.7%) needed reposition of the implant and 3 eyes (4.3%) required inlay explantation, due to progressive hyperopia, epithelial ingrowth or intolerable impaired night vision respectively. 58 of 69 patients (85%) were satisfied with the visual results, particularly with their vision without reading glasses.

Distance Visual Acuity (Decimal values) -Eye with the inlay-

Uncorrected Near and Intermediate Visual Acuity (Jaeger Values) -Eye with the inlay-

Comparative Chart of Spherical Equivalent Values -Eye with the inlay-

Comparative Chart of Uncorrected Visual Acuity -Eye with the inlay-

Conclusion The results obtained suggest that implantation of a small-aperture inlay in presbyopic patients, is a clinically safe and effective alternative to improve near and intermediate vision in presbyopic patients, with a minimal effect on distance vision, with a relatively low rate of complications, although a number of interventions were required in many cases to obtain the desired outcome of patient satisfaction and less dependence on reading glasses.