University of California, San Diego Shiley Eye Center

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Presentation transcript:

University of California, San Diego Shiley Eye Center M ini-Enhancement of LASIK Nicole Brandt, M.D. / Myoung Joon Kim, M.D. Tracy Purcell, Ph.D. / David J. Schanzlin, M.D. University of California, San Diego Shiley Eye Center No author has a financial or proprietary interest in any material or method mentioned.

INTRODUCTION LASIK enhancements are generally safe and effective for the treatment of residual visual complaints such as blurry vision, decreased night vision and monocular diplopia.* Most physicians perform enhancements when the refractive error is greater than 1 D and UCVA ≤ 20/40. What about the treatment for small residual refractive errors (Spherical equivalent < ±1 D and UCVA > 20/40)? Does the risk of enhancement in these patients outweigh the benefit? * Retreatment of LASIK, J Refract Surg 2006

INTRODUCTION During our literature search, we were unable to find any studies that focused on the enhancement of small refractive errors or Mini-Enhancements. PURPOSE We performed a retrospective study on a subset of patients: 1) To characterize patients who underwent Mini-Enhancements 2) To investigate visual outcomes of Mini-Enhancements 3) To evaluate complications of Mini-Enhancements

METHODS We performed a retrospective chart review on all LASIK patients treated by one surgeon (DJS) from January 2007 through December 2007 that required a Mini-Enhancement. Primary Procedure: LASIK flap creation with IntraLase Myopic treatment targeted at plano Definition of Mini-Enhancement: Enhancement of a residual refractive error that is less than 1 D in spherical equivalent. Laser Platform for Enhancement: VISX STAR S4 IR (AMO, Santa Ana, CA)

RESULTS Patient Demographics: 41 eyes in 29 patients Patient Age: 43.9±10.1 years Bilateral Mini-Enhancement: 12 patients (41.4%) Duration between primary LASIK to enhancement: 8.40±4.62 months (range 2.5 to 8 months) Enhancement procedure: Flap lift : PRK = 37 : 4 Standard : Custom = 35 : 6

RESULTS Pre-enhancement refractive errors: SPH -0.62±0.40 D (range +0.50 to -1.50) CYL 0.49±0.36 D (range Plano to +1.50) CYL ≥0.75 D : 13 eyes (31.7%) CYL ≤0.50 D : 28 eyes (68.3%) UCVA Pre-enhancement, LogMAR: 0.14±0.13 (LogMAR 0.14 = 20/27.8) UCVA Post-enhancement, LogMAR, at 1 month: -0.04±0.09 (LogMAR -0.04 = 20/18.3)

UCVA Pre and Post-Enhancement RESULTS UCVA Pre and Post-Enhancement Number of Eyes

RESULTS Post-Enhancement Gain of UCVA within 3 months Number of Eyes 19.5% 80.5% Number of Eyes Number of Lines of UCVA gained

82.9 % of eyes achieved UCVA ≥ Pre-enhancement BSCVA RESULTS Pre-Enhancement BSCVA vs. Post-Enhancement UCVA 17.1% 82.9% Number of Eyes Difference in Lines of Visual Acuity 82.9 % of eyes achieved UCVA ≥ Pre-enhancement BSCVA

RESULTS Complications (Cx) Flap striae: 4 eyes (10.8% of the Flap Lifts) Postoperative UCVA in eyes with flap striae 20/20 1 eye 20/25 1 eye 20/30 2 eyes 4 eyes

CONCLUSION Overall, Mini-Enhancements were quite successful and showed excellent visual outcomes. 81% of patients gained 1 or more lines of UCVA. No patients lost UCVA after mini-enhancement. 83% achieved UCVA = pre-enhancement BSCVA Of the patients who did not achieve pre-enhancement BSCVA, approximately one-third were due to flap striae.