1. GUSTAVO TAMAYO MD CLAUDIA CASTELL MD
CENTRO OFTALMOLOGICO
GUSTAVO TAMAYO
BOGOTA COLOMBIA
LASIK XTRA
GUSTAVO TAMAYO MD CLAUDIA CASTELL MD
PILAR VARGAS MD
From: BOGOTA LASER REFRACTIVE INSTITUTE
Bogota, Colombia

2. DISCLOSURES FOR GUSTAVO TAMAYO MD
Member of the Advisory Board for AMO Inc.
Member of the Advisory Board PRESBIA Corp.
Member of the Advisory Board EYEGENICS Corp.
Member of the Speakers Group for AVEDRO
Member of speakers group of KERAMED
Patent holder of a Presbyopia treatment

3. LASIK XTRA A new concept: KXL at the time of a LASIK surgery.
There is no doubt any surgery involving the creation of a flap will decrease the strength of the cornea.
Microkeratomes decrease the corneal strenghth two times more than Femtosecond flaps (own published studies).
If the addition of KXL does not change the final result: WHY NOT?

4. LASIK XTRA
Very short procedure: one minute soaking time and one minute fifteen seconds UV.
Does not change the normal LASIK procedure itself.
Same ablation, same handling of the flap.
In my own cases we did not detect any change in the refractive result.
No complications added at all to the normal regular procedure of LASIK.

5. INCORPORATING LASIK XTRA INTO STANDARD LASIK SURGERY
Avedro’s VīBex Riboflavin is applied to the flap bed:
Isotonic
0.1% riboflavin
20% Dextran T500
pH 7.0
Following excimer laser ablation in the flap bed
The flap is repositioned and the cornea is then
exposed to 30mW/cm2
UVA for 2 minutes

6. LASIK XTRA ADVANTAGES
Can be carried out with Intralase or with Microkeratome flap.
Do not change the regular procedure.
Easy and simple for Doctor and Patient.
Do not change the final result of the ablation.
Can also be used regardless of the thickness of the flap, depth of ablation or type of Excimer Laser.

7. LASIK XTRA DISADVANTAGES
Slows down the procedure for a couple of minutes.
Increases the cost.

8. LASIK XTRA INDICATIONS STRONG CONSIDERATIONS
ABSOLUTELY CONTRAINDICATED IN THE PRESENCE OF ECTASIA.
ABSOLUTELY NOT INDICATED WHEN DEVELOPMENT OF ECASIA IS WARRANTED.
In such a case I prefer Surface Ablation plus Accelerated Cross Linking.

9. LASIK XTRA INDICATIONS
Young patients for Lasik (under 24 years of age).
Patients with severe ocular allergies, due to the risk of heavy rubbing.
Completely normal corneas, with no one sign of Keratoconus, but family history.
Thin corneas with complete normal preoperative evaluation (Risk of ectasia has been ruled out).
High myopes (large resections)

10. LASIK XTRA INDICATIONS
Retreatments, particularly if the thickness of the flap is not known.
Unexpected thick flap.
Irregular flaps with different thickness.
FINALLY IN ALL LASIK CASES: IF IT DOES NOT CHANGE THE RESULT WHY NOT???

11. LASIK XTRA: Predictable Visual Outcomes
Retrospective Comparison of 66 Lasik eyes to 42 LASIK eyes treated for myopia
Mean age: in the Lasik Xtra cohort and in the LASIK cohort
Mean preoperative MRSE was D (Lasik Xtra), and D (LASIK).
No adjustment was made to the excimer laser treatment nomogram to account for aCXL, which was performed immediately following stromal ablation

12. LASIK XTRA: Predictable Visual Outcomes
Retrospective Comparison of 66 Lasik eyes to 42 LASIK eyes treated for myopia
Mean UCVA at 1 Day Post-Op
20/21 Lasik Xtra vs 20/20 LASIK
Mean UCVA at 1 Week Post-Op
20/20 Lasik Xtra vs 20/20 LASIK
Mean UCVA at 1 Month Post-Op
20/18 Lasik Xtra vs 20/20 LASIK

13. LASIK XTRA: Predictable Visual Outcomes
Retrospective Comparison of 66 Lasik eyes to 42 LASIK eyes treated for myopia
Mean MRSE at 1 Week Post-Op
+0.17 Lasik Xtra vs LASIK
Mean MRSE at 1 Month Post-Op
+0.49 Lasik Xtra vs LASIK

14. LASIK XTRA: Predictable Visual Outcomes
UCVA 1 Day Post Operative

15. LASIK XTRA: Predictable Visual Outcomes
UCVA 1 Month Post Operative

16. LASIK XTRA EXAMPLE # 1
PREOPERATIVE
POSTOPERATIVE

17. LASIK XTRA EXAMPLE # 2
PREOPERATIVE
POSTOPERATIVE

18. LASIK XTRA EXAMPLE # 2
PREOPERATIVE
POSTOPERATIVE

19. CONCLUSION LASIK XTRA
No need to change nomogram for LASIK procedures (Femto or microkeratome).
No change in the final results when compared to same procedures without KXL.
No haze or loss of lines of BCVA.
Time for surgery is increased only few more minutes.
Follow up only one year and one eye retreatment in 100 eyes.
Lifting the flap was very easy (surgeon was not aware of the KXL at the time of relifting).

20. Gracias