Kh.P.Takhchidi, O.A. Kostin1, A.A. Stepanov1 , A.I. Ovchinnikov1.

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Presentation transcript:

Kh.P.Takhchidi, O.A. Kostin1, A.A. Stepanov1 , A.I. Ovchinnikov1. COMBINATION OF HYPEROPIC AND MYOPIC ABLATION ALGORYTHMS FOR CORRECTION OF SPHERIC ABERRATION APPEARING DURING CORNEA ABLATION FOR MYOPIA CORRECTION Kh.P.Takhchidi, O.A. Kostin1, A.V.Doga, S.V. Rebrikov,1, A.A. Stepanov1 , A.I. Ovchinnikov1. IRTC Eye Microsurgery State Enterprise named after S.N. Fyodorov, Moscow, Russia Ekaterinburg Branch1

J Refract Surg. 2000 Jul-Aug;16(4):407-13

AIM To develop the technology for correction of spheric aberration appearing during excimer laser cornea ablation for myopia correction To compare refraction, visual acuity, and spheric aberration after wavefront-guided and combined excimer laser surgery

PATIENTS AND METHODS Aberrometry with 6 mm diameter - WASCA aberrometer (Carl Zeiss Meditec) Keratotopography – ATLASTM 995 (Carl Zeiss Meditec) Flap formation - Hansatome Excellus microkeratome (B&L) Excimer laser ablation with 6 mm diameter - MEL-80 excimer laser (Carl Zeiss Meditec) Wavefront-guided ablation was performed with the use of CRS-Master (Carl Zeiss Meditec) Combined ablation was performed in 2 steps during one operation: Myopic ablation with the depth corresponding to the degree of myopia increased by 2.0 D for mild myopia and by 2.5 D for moderate myopia. Hyperopic ablation with the depth corresponding to +1.0 D for mild myopia and +1.5 D for moderate myopia.

PATIENTS AND METHODS Group 1 Group 2 Postoperative follow-up 6 months wavefront-guided LASIK combined LASIK 20 patients (40 eyes) 14 patients (20 eyes) SE – 4,67 D ± 1,94D (range, -1,5 D to – 7,63D) SE – 3,93 D ± 1,05D (range, -2,75 D to – 7,00D) UCVA 0,05±0,02 BCVA 1,0±0,06 Z (4,0) 0,08 ± 0,23 μm (Malacara notation) RMS HO: 0,28 ± 0,21μm UCVA 0,05±0,02 BCVA 1,00 Z (4,0) 0,01 ± 0,19 μm (Malacara notation) RMS HO 0,24 ± 0,07μm Postoperative follow-up 6 months

REFRACTIVE EFFECT (6 months) RESULTS REFRACTIVE EFFECT (6 months) Group 1 - wavefront-guided LASIK Group 2 - combined LASIK a c h i e v d p l a n n e d

RESULTS REFRACTION CHANGES Group 1 - wavefront-guided LASIK Group 2 - combined LASIK before 1 month 3 mos. 6 mos. before 1 month 3 mos. 6 mos.

RESULTS VISUAL ACUITY CHANGES

RESULTS HIGHER ORDER ABERRATIONS RMS HO (μm) Spheric aberration (Malacara notation,μm) WAVEFRONT- GUIDED LASIK COMBINED LASIK Before 0,24 ± 0,07 0,28 ± 0,21 0,08 ± 0,23 0,01 ± 0,19* 6 months after 0,48 ± 0,23 0,33 ± 0,13 -0,53 ± 0,21 -0,01 ± 0,26* * p>0,05

RESULTS WAVEFRONT- GUIDED LASIK OD COMBINED LASIK OS Numerical keratotopographic map 6 months after surgery. A significant increase of corneal refraction (marked with red oval) from cornea center (0 mm) to the periphery (6 mm) is seen in wavefront – guided LASIK group (∆ 0,94 D) while it is almost absent in combined LASIK group (∆ 0,17 D).

RESULTS WAVEFRONT- GUIDED LASIK OD COMBINED LASIK OS The value of spheric aberration 6 months after surgery (red arrow indicates the numeric value of spheric aberration). A significant increase of negative spheric aberration in wavefront – guided group (Z(4,0) - 0.674 µm, Malacara notation) compared to combined LASIK (Z(4,0) 0.000 µm, Malacara notation).

CONCLUSIONS During customized correction of higher order aberrations it is necessary to take into consideration not only preoperative wavefront aberration data, but also biomechanical changes of the cornea taking place during ablation Combination of myopic and hyperopic ablation during correction of myopia is able to correct spheric aberration appearing due to ablation-induced biomechanical changes of the cornea