1. and High-Order Aberrations After Intrastromal Presbyopia Correction
Corneal Asphericity
and High-Order Aberrations
After Intrastromal Presbyopia Correction
ASCRS 2011, San Diego
© AMAR R. 2010
The authors have no financial interest in the subject matter of this e-poster
Raphaël AMAR OD [1,2] , Cati ALBOU-GANEM MD [1,3] , Dan A. LEBUISSON MD [1,2] ,
Arié DANAN MD [1] , Than HOANG XUAN MD [1,2]
[1] Clinique de la vision, Paris, France
[2] American Hospital of Paris, Department of Ophtalmology, Neuilly/Seine, France
[3] XV-XX National Ophtalmology Hospital, Paris, France

2. PURPOSE
• To evaluate the corneal asphericity & aberrometric changes after INTRACOR™ procedure.
• INTRACOR™ or intrastromal correction of presbyopia allows presbyopia correction via intrastromal reshaping with the femtosecond laser creating 3 mm concentric circles leading to a convexity and multifocality in the central cornea.
D+1
Post op M3
Pré op
© AMAR R. 2011

3. INTRACOR™: Intrastromal Correction of Presbyopia by femtosecond Laser
Non invasive technique, No flap
Intrastromal focus of the femtoseconde laser
Differencial Map between preoperatively
and 3 monts postoperatively
Orbscan – Anterior Tangential Power Map
3 mm concentric circles (5) leading
to a convexity and multifocality in the central cornea.

4. INTRACOR™: Intrastromal Correction of Presbyopia by femtosecond Laser
Scheimpflug
analysis M+1
Slit Lamp D+7
© AMAR R. 2011

5. INTRACOR™: Intrastromal Correction of Presbyopia by femtosecond Laser
SIMULTANEOUS VISION

6. METHODS
Prospective study on 52 emmetropic or slightly hyperopic presbyopic patients, performed at the Clinique de la Vision in Paris.
Inclusion criteria on refractive level:
BCVA>20/32,
Sphere from 0,00 to +1,00D
Cylinder from -0,75 to 0,00 D,
Addition up to +1,50D
Exclusion criteria:
Sphere > +1,00 D; Cylinder > -0,75 D
Kappa angle> 10°
Pachymetry < 500 microns (Thinnest point)
INTRACOR™ treatment was only performed on the non-dominant eye.
Corneal asphericity (6 mm zone), Root Mean Square (RMS) (6 mm zone), value of high order aberrations and corneal spherical aberration (6 mm zone) were analyzed preoperatively and 3 months after the treatment by the Allegro Oculyzer System (Alcon) and by the ZYWAVE aberrometer (Hartmann Shack aberrometer - Technolas Perfect Vision).
N (eyes) 52
patients
Women/Men
27W/25M
Mean age ± SD
54,7 ± 5,1
[44; 64]
SPHERE
+ 0,60 ± 0,33 D
0,00 ; +1,00
CYLINDER
- 0,23 ± 0,24 D
-0,75 ; 0,00 SE
+ 0,47 ± 0,33 D
-0,37 ; +1,12

7. RESULTS CORNEAL ASPHERICITY (ALLEGRO OCULYZER System)/ 6MM
CORNEAL SPHERIC ABERRATION / ALLEGRO, OCULYZER/ 6MM
PRE OP
POST OP
Z 4,0
Anterior shape
0,73 ± 0,19
[0,49 ; 1,11]
0,61 ± 0,19
[0,21 ; 0,90]
Posterior shape
0,72 ± 0,27
[0,17 ;1,22]
0,48± 0,28
[-0,10 ;0,99]
PRE OP
POST OP
Q factor
Cornea 6 MM
-0,16 ± 0,15
[-0,4 ; 0,04]
-0,26 ± 0,16
[-0,5 ; -0,02]
p < 0,05
Z 4,0
Anterior shape
Z 4,0
Posterior shape
N=52

8. RESULTS PRE OP microns POST OP RMS 1,1 ± 0,47 [0,59 ; 2,19]
0,94 ± 0,31
[0,45 ; 1,41]
HOA RMS
0,47± 0,23
[0,20 ;0,65]
0,51± 0,19
[0,34 ;0,86]
Z 4,0
0,20 ± 0,12
[0,41 ; 0,04]
0,10 ± 0,13
[-0,17, +0,31]
Vertical Coma
- 0,16 ± 0,21
[-0,21 ; 0,67]
0,02 ± 0,16
[-0,24 ; 0,34]
Horizontal Coma
- 0,08 ± 0,20
[-0,19 ; 0,46]
- 0,09 ± 0,17
[-0,14 ; 0,35]

9. DISCUSSION
Corneal asphericity decreased from - 0,16 ± 0,15 microns preoperatively to - 0,26 ± 0,16 microns at 3 months postoperatively.
Spherical aberrations of anterior cornea (anterior shape) decreased from 0,73 ± 0,19 microns preoperatively to 0,61 ± 0,19 microns at 3 months postoperatively.
Spherical aberrations of posterior cornea (posterior shape) decreased from 0,72 ± 0,27 microns before treatment to 0,48 ± 0,28 microns at 3 months postoperatively .
HOA RMS increased following the INTRACOR treatment compared to preoperative measurements, increasing from 0,47 ± 0,23 [0,20; 0,65] to 0,51 ± 0,19 [0,34; 0,86] (p<0,05).

10. DISCUSSION HOA RMS= 0,59 MICRONS RMS = 0,84 MICRONS
Example: M / 47 years old,
Preoperatively refraction Non dominant eye: Left Eye: +0,75= 20/20
Preoperatively and 15 days postoperatively Zywave evaluation
Preoperatively
15 days Postoperatively
HOA RMS= 0,59 MICRONS
RMS = 0,84 MICRONS
HOA RMS= 0,44 MICRONS
RMS = 0,73 MICRONS

11. Total Spherical Aberration Total Spherical Aberration
DISCUSSION
Example: M / 47 years old,
High Order Aberrations changes,
Pre op
Post op
Total Spherical Aberration
Total Spherical Aberration

12. CONCLUSION REFERENCES
The INTRACOR technique is a promising technique for the surgical correction of the presbyopia. The results confirm the efficiency for near vision [1,2] with a good modification of the corneal asphericity and spherical aberration after surgery. The slights changes in higher order aberrations confirms the good outcomes of quality of vision after the INTRACOR procedure.
The crucial point is the centering of the procedure.
Larger series and longer follow up must be needed to reinforce the proof of the efficiency issue of this procedure.
INTRACOR ™ technique is not FDA approved.
REFERENCES
1. Ruiz LA, Cepeda LM, Fuentes VC.
Intrastromal correction of presbyopia using a femtosecond laser system
J Refract Surg Oct; 25 (10):847-54
2. Holzer MP, Mannsfeld A, Ehmer A, Auffarth GU.
Early outcomes of Intracor femtosecond laser treatment for presbyopia
J Refract Surg Oct; 25 (10):855-61