1. V
isual Outcomes and Complications of Mini-Enhancements after Refractive Surgery
Lichtinger A, MD; Purcell TL, Ph.D; Bernabe-Ko J, MD; Schanzlin DJ, MD.
The authors have no financial interest in the subject of this poster

2. INTRODUCTION Refractive enhancements Safe and Effective
Performed when:
Error >1 D
UCVA < than 20/30
What about the treatment for small residual refractive errors?
Spherical equivalent, sphere and/or cylinder all < 1 D
UCVA ≥ 20/30
Do the risks of enhancement in these patients outweigh
the benefits? 2

3. INTRODUCTION
No available literature on Mini-Enhancements
PURPOSE:
To analyze the visual outcomes, risks and complications resulting from Mini-Enhancement procedures after myopic keratorefractive surgery.

4. METHODS July 2007 through June 2008 at UCSD Shiley Eye Center
Retrospective chart review
July 2007 through June 2008 at UCSD Shiley Eye
Center
Primary Procedure:
LASIK flap creation with femtosecond laser or PRK
Treatment targeted at plano
All surgeries performed by same surgeon
Definition of Mini-Enhancement:
Less than 1 D in spherical equivalent, sphere
and/or cylinder
UCVA ≥ 20/30

5. METHODS Patient Demographics: 160 Enhancement procedures
44 met Mini-Enhancement criteria (27.5%)
37 myopic and 7 hyperopic eyes
Age: ±10.7 years
8 bilateral cases
Elapsed time between primary procedure to Mini-Enhancement:
9.67±4.6 months (range 4 to 23 months)
Enhancement procedure:
Flap lift : PRK = 31 : 6
Because our hyperopic group was small, only data on the primary myopic patients is presented here.

6. RESULTS SAFETY: 4 eyes (10.8%) lost a mean 2.2 letters of BCVA
No eye lost 1 or more lines of BCVA
BCVA improved from 20/20+2 to 20/15-2
Safety index: 1.5

7. RESULTS EFFICACY: At last follow up mean UCVA was 20/20+2
76% of eyes achieved an UCVA ≥ 20/20 and 100% achieved ≥ 20/25
Efficacy index: 0.98

8. RESULTS PREDICTABILITY: At last follow-up mean MRSE was -0.08 D
Final MRSE was within ± 0.25 D of emetropia in 72.9% of eyes and within ± 0.50 D in 91.8%
All eyes were within ± 1.0 D of emetropia

9. RESULTS COMPLICATIONS: 5 out of 44 eyes
2 cases of epi-ingrowth (Only 1 required an episcrape); final UCVA 20/15 and 20/15-1
2 cases were refloated due to striae; final UCVA 20/15 and 20/20-1
1 case of interface debris in which the flap was refloated; this is the only eye that lost more than 1 line of UCVA (Lost 9 letters)

10. RESULTS Shorter time span between primary treatment and
RISK FACTORS FOR SUBOPTIMAL VISUAL OUTCOMES (UCVA < 20/20):
Initial higher myopic defocus ( vs ; p =0.02)
Shorter time span between primary treatment and
Mini-Enhancement ( 5.1 vs. 8.2 months; p = 0.008)

11. CONCLUSION
Overall, Mini-Enhancement after myopic refractive surgery proved to be effective with minimal complications and good visual outcomes
76% of eyes achieved 20/20 or better UCVA.
72.9% were within ± 0.25 D of emetropia
Before a Mini-Enhancement we suggest to consider the initial myopic defocus and to wait for at least 6 months after the primary procedure

12. CONCLUSION
Mini-Enhancements in our series appears to be safe and delivers excellent visual outcomes
We can consider this type of enhancement in patients that are still symptomatic or uncomfortable with the achieved visual results after primary myopic keratorefractive surgery
Data derived from this study may be helpful when discussing the potential risks and benefits of an enhancement in this specific population