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Topography-Guided Photorefractive Keratectomy (TG-PRK) and Simultaneous collagen cross- linking (CXL) in Post-LASIK Ectasia Using 2 High-Resolution Excimer.

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Presentation on theme: "Topography-Guided Photorefractive Keratectomy (TG-PRK) and Simultaneous collagen cross- linking (CXL) in Post-LASIK Ectasia Using 2 High-Resolution Excimer."— Presentation transcript:

1 Topography-Guided Photorefractive Keratectomy (TG-PRK) and Simultaneous collagen cross- linking (CXL) in Post-LASIK Ectasia Using 2 High-Resolution Excimer Lasers Simon Holland David TC Lin ASCRS, Chicago, Illinois 2012 No financial interests

2 Purpose To evaluate the early efficacy and safety of TG-PRK combined with simultaneous CXL in post-LASIK ectasia for correction of irregular astigmatism using the IVIS and Allegretto platforms

3 Methods Using 2 high-resolution excimer lasers for TG-PRK, modified by TNT (topographical neutralization) - trans epithelial technique (n=17) Riboflavin 0.1% in dextran, until aqueous staining UV irradiation with riboflavin (up to 20 minutes) UV 370 um, 3mW/cm J/m2 Hypotonic dextran if <400 um Bandage contact lens, standard post PRK management Symptom scor -pre and post-operative uncorrected visual acuity (UVA), best corrected visual acuity (BCVA), manifest refraction (MR) predictability, safety

4 TG-PRK with CXL for ECTASIA Original Topography: UCVA: 20/100 Pre-op: -2.00sph BSCVA: 20/20 CT: 553

5 TG-PRK with CXL for ECTASIA 4.5 years post LASIK8 months post-op UCVA: 20/200 UCVA: 20/20 MR: x100 20/30MR: PL-0.25X180 20/20 CT: 500

6

7 TG PRK CXL for ECTASIA UCVA: 20/40012 month post-op Pre-op: x100UCVA: 20/30 - BSCVA: 20/80RX: x /30 -

8 TG CXL PRK for Ectasia 26 years old male LASIK x 5 years 3 months post-op UCVA : 20/60 UCVA: 20/30 - MR: x125 20/30MR:Pl-0.75x180 20/25+ CT : 552CT : 544

9 Results 17 patients completed 6 months post-operatively 12/17 (71%) had UVA of 20/40 9 (53%) gained 2 lines or more BCVA; 1 (6%) lost 2 lines or more Mean reduction of astigmatism 2.56D All but two symptomatically improved Complications included delayed epithelialization No progression of ectasia noted up to 18 mth No significant differences in the small sample sizes iVIS central corneal regularization does not induce as much myopia as the Allegretto when used with TNT iVIS - less gain in BSCVA

10 Conclusions Early results of TG-PRK with simultaneous CXL using two laser platforms shows promise as an effective treatment for highly symptomatic patients with post-LASIK ectasia All but two had improved symptoms 71% of patients had 20/40 or better UVA More than half gained 2 lines of BSCVA

11 TG PRK-CXL Summary – 2 platforms, 2 conditions Analysis KC with Allegretto KC with iVIS Ectasia with both lasers Patients completed 6 months post-op UVA 20/40 54%42%71% Gained 2 lines or more BCVA 32%9%53% Average reduction of astigmatism 1.63D1.17D2.56D

12 TG CXL PRK for KERATOCONUS Pre-op: x months post-op BSCVA: 20/30 - UCVA: 20/30 RX: x170 20/25

13 Pre-op6 months post-op UCVA: CFUCVA: 20/50 - MR: X110 20/60 + MR: x180 20/40 - iVIS TG-PRK with CXL for KC

14 TG PRK CXL for ECTASIA UCVA: 20/40012 month post-op Pre-op: x100UCVA: 20/30 - BSCVA: 20/80RX: x /30 -

15 KC – Allegretto PreOp: x060 20/ months PostOp: x170 20/25 KC – iVIS PreOp: x050 20/60 6 months PostOp: -1.00sph 20/40 Ectasia PreOp: x100 20/80 12 months PostOp: x /30

16 Allegretto vs iVIS Induced myopia, larger optical zone Mixed cylinder - smaller optical zone

17 TG PRK with Cross-linking for Keratoconus and Ectasia: Concerns Thinning an already thin cornea - long term stability unknown Predictability - hyperopic surprises - less than expected even with target Endothelial damage, delayed epithelialization

18 TG PRK with Cross Linking: Impressions Effective in both KC and Ectasia in early studies for highly symptomatic CL intolerant patients Reduce nomogram for TNT in ectasia Topograpgical neutralization techniques mostly effective for correcting for induced refractive error from TG PRK – across platforms and for both KC and ectasia


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