Moderator
Dagny Zhu, MD, ABO
Panelists
Michael Mimouni, MD
Jason R. Mayer, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Ceren Ece Semiz, MD
Co-Authors
Faruk Semiz MD, Njomza H MD, Fetih Furkan Arslan MD
Purpose
To demonstrate that hyperopic residual refraction after LASIK and presbyopia can be effectively treated by modifying the corneal shape (Q value) through intrastromal fresh myopic lenticule transplantation (FMLT).
Methods
This retrospective study involved 64 eyes of 32 patients aged 38-55 with residual hyperopic refraction after LASIK between +0.75 and +2.75 D, presbyopia +1.50 - +4.50 D and astigmatism +0.75- +2.50 D. The inclusion criteria were residual hyperopic refraction and low visual acuity. Patients with active anterior segment pathology, glaucoma, and retinal detachment were excluded. The flap of LASIK was not touched or lifted. A stromal pocket was created using the VisuMax femtosecond laser with an 8.0 mm diameter and a cap thickness set to 140 ?m and 4 mm superior incision. FMLT was performed using the SMILE module guided by corneal topography, and patients were followed for 1 year. (NCT04793893)
Results
Significant improvements were observed in uncorrected distance visual acuity (UDVA), with values changing from 0.67 � 0.08 Log MAR preoperatively to 0.07 � 0.05 Log MAR at 12 months (p<0.001). uncorrected="" near="" visual="" acuity="" (unva)="" at="" 40="" cm="" improved="" from="" j7="" to="" j2="" postoperatively,="" and="" at="" 80="" cm="" from="" j6="" to="" j3="">
Conclusion
FMLT is a reliable technique for treating residual refractions after LASIK and presbyopia. It improves near, intermediate, and distance visual acuity by altering the corneal shape.
Presenting Author
Ceren Ece Semiz, MD
Co-Authors
Faruk Semiz MD, Njomza H MD, Fetih Furkan Arslan MD
Purpose
To evaluate visual acuity following myopic lenticule implantation in pseudophakic patients with hyperopic residual refraction and presbyopia, aiming to assess improvement in visual outcomes.
Methods
This retrospective study included 32 patients (64 eyes) aged 41-62 with hyperopic residual refraction after trifocal IOL implantation and presbyopia. The residual hyperopia ranged between +0.75 and +1.75 D, presbyopia between +1.00 and +2.50 D, and astigmatism between +0.50 and +1.25 D. Patients with active anterior segment pathology, corneal/anterior segment surgery, glaucoma, and retinal detachment were excluded. The procedure included creating a 7.70 mm stromal pocket with a 130 ?m cap thickness and a 4mm incision via SMILE module. A fresh myopic lenticule, 0.5 D higher than the residual diopter, was implanted according to the low K value. Patients were monitored for 1 year. NCT04692012
Results
UDVA significantly improved from 0.62�0.09 LogMAR preoperatively to 0.08�0.05 at one year post-op (p<0.001). unva="" at="" 35cm="" improved="" from="" 6j="" to="" 2j=""><0.001), and="" unva="" at="" 70cm="" improved="" from="" 6j="" to="" 3j=""><0.001) at="" year="" post-op.="" the="" surgical="" intervention="" positively="" impacted="" both="" near="" and="" distance="" visual="" acuity="">
Conclusion
In conclusion, fresh myopic lenticule implantation via SMILE presents as an effective solution for addressing residual hyperopia and presbyopia after trifocal IOL implantation. This approach not only enhances vision but also contributes to overall patient satisfaction.
Presenting Author
Stephen A. Wexler, MD, ABO
Purpose
To evaluate safety and efficacy of a new ray tracing�based technology for LASIK to correct myopia in eyes with and without astigmatism. Ray tracing guided vision correction is a treatment algorithm for calculating and optimizing ablation profiles.
Methods
This prospective, single-arm, interventional study was performed by a single surgeon at a single site. Included were patients ?21 years-old with mean myopia of -4.00 D (range -7.00 to -1.00), with mean astigmatism of -0.84 D (range -2.25 to 0.0). For each eye, a virtual 3D model and individualized ablation profile was developed using data collected from a new device (InnovEyes� Sightmap) and processed by a new and unique ray tracing algorithm. This device integrates three diagnostic measures: wavefront profile, whole eye biometry, and scheimpflug tomography, along with auto-refraction. Efficacy and safety were evaluated at three months.
Results
All 11 patients (22 eyes) enrolled were evaluated at 3 months post-op; 100% of eyes achieved UDVA of 20/20 or better, 91% of eyes achieved UCDV of 20/16 or better, and 45% of eyes achieved UCDV of 20/12.5. Eighty-two percent of eyes had UCDV equal to or better than the pre-op BCDV. Nine percent of eyes gained at least 1 line of BCVA while no eyes lost any lines CDVA. There were no new safety signals at 3 months; no ocular SAEs or non-ocular adverse device effects were reported.
Conclusion
Ray tracing-based LASIK treatment was safe and effective for correcting myopia in individuals with and without astigmatism, producing excellent visual outcomes.
Presenting Author
Arun C. Gulani, MD, ABO
Co-Authors
Aaishwariya Gulani MD
Purpose
To present an universally effective and efficient technique for removal of Implantable Collamer Lenses (ICL) that can be performed in under two minutes, utilizing a 3-step method designed to minimize trauma and enhance patient outcomes.
Methods
This 3-step technique involves: 1.Differential Visco-Levitation to differentially elevate and free the ICL from its seated position, ensuring minimal anatomical disturbance. 2.Rotational Manipulation: Precise rotation of the ICL to disengage it from its adherent position, facilitating easier handling from the Astigmatically steep axis in preparation for refractive Cataract surgery. 3.Extraction: A precise and effective extraction process with minimal maneuvering to remove the ICL in toto.
Results
The 3-step technique was performed on a series of patients requiring ICL removal prior to refractive cataract surgery, and within two minutes, demonstrating its efficacy and reproducibility. Postoperative outcomes showed no significant complications, and the surgical approach was well-received by patients and surgical teams alike.
Conclusion
This 3-step ICL removal technique provides a quick, effective, and safe method for extracting ICLs. Surgeons can universally achieve excellent results with minimal patient discomfort and reduced surgical time, while also maintaining a premium patient experience and vision outcome.
Presenting Author
Sung Min Kim, MD
Purpose
To evaluate the accuracy and reproducibility of cap thickness for lenticule extraction surgery of 5 femtosecond lasers.
Methods
From myopia and myopic astigmatism patients who underwent lenticule extraction surgery, 150 eyes were collected and cap thickness was measured at 1 week post-op. Femtosecond lasers were performed with VisuMax 500(Zeiss), VisuMax 800(Zeiss), ATOS(Schwind), Z8(Zeimer) and ELITA(Johnson & Johnson). From each, 30 random eyes were collected and analyzed. Cap measurements were obtained by Cirrus 500 HD OCT at 5 points(center, nasal and temporal 3mm zone, nasal and temporal 6mm zone). Pre-operative intended cap thickness was between 100um and 120 um and accuracy(difference between the mean and intended cap thickness) and reproducibility(cap thickness standard deviation between eyes) were analyzed.
Results
Average central cap thickness for each femtosecond laser was ELITA: 100.3�2.5um, ATOS: 108.1�6.0um, Z8: 101.9�6.1um, VisuMax 800: 103.9�3.5um and VisuMax 500: 103.2�3.1um, respectively. ATOS machine showed significantly thin central cap compared to the others and it was the only machine to be thinner than the intended cap thickness(-6.9�5.0um, p=0.000). In peripheral 6mm zone, ELITA showed significantly thick cap compared to the others(temporal 6mm: 28.1�9.7um, nasal 6mm: 26.5�7.9um). Z8 showed the lowest gap between the intended versus measured central cap thickness(-0.1�3.5um).
Conclusion
All femtolaser machines showed high accuracy and good reproducibility in cap formation. ATOS had tendency to form thinner cap then intended, whereas the other machines formed mostly slight thicker cap. Due to biconvex lenticule design, peripheral cap thickness of ELITA was thicker than the others.
Presenting Author
Sanjay Chaudhary, MS
Co-Authors
Rahil Chaudhary MS, HEMA Mehra MS, Alka Pandey MS
Purpose
The aim of this study is to compare the vault differences of the same size Implantable Collamer Lens (ICL) in both eyes of the same patient, where one ICL is aligned horizontally and the other vertically.
Methods
This prospective, non-randomized study included 96 patients who underwent bilateral myopic ICL implantation. In one eye the ICL was aligned horizontally and vertically in the other eye. ICL sizing parameters were assessed using the Pentacam (OCULUS), and postoperative vaults were measured on day 1, day 15 and at 3 months using Anterion SS-OCT (Heidelberg). Only cases with identical ICL sizes in both eyes were evaluated. The study represents the first planned prospective comparison of vaults in both eyes of the same patient with similar White-to-White (WTW) measurements and ICL sizes.
Results
ICL sizing in the study population was distributed as follows: 8 patients with 12.1 mm, 46 patients with 12.6 mm, 38 patients with 13.2 mm, and 4 patients with 13.7 mm ICLs. Of the 96 patients, 94 (97.9%) had lower vaults in vertically aligned ICLs, while 1 patient (1.04%) had a higher vertical vault, and 1 patient (1.04%) had equal vaults in both alignments. The mean vault difference in patients with lower vertical vaults was 232.14 microns. The mean vault differences were 105.62 microns for 12.1 mm ICLs, 211.89 microns for 12.6 mm ICLs, 301.2 microns for 13.2 mm ICLs, and 149 microns for 13.7 mm ICLs.
Conclusion
A horizontally implanted ICL typically results in a higher vault, which can be reduced by rotating the ICL vertically, with an average reduction of 232.14 microns. Vault differences also vary according to ICL size, with the smallest vault differences observed in 12.1 mm ICLs and the largest in 13.2 mm ICLs.
Presenting Author
Ivan Gabric, MD
Co-Authors
Victor Derhartunian MD
Purpose
Laser induced optical breakdown is a major but mostly unexplored factor in KLEx. By standard most doctors accept that under 1000 mJ/cm2 as low dose. This work was our guide as we wanted to explore sub 500 mJ/cm2 range in KLEx on Schwind ATOS and what this means for lenticule extraction and patient recovery - UCVA and sine wave contrast sensitivity.
Methods
We treated over 250 eyes using sub 500 mJ/cm2 and using a stairstep approach reached the lowest dose so far of 29w mj/cm2 at which lenticule dissection was possible but approaching very difficult. Our start point was 750 mJ/cm2 power level with mild asymmetric settings. We then proceeded to lower the dose in increments of 25 mJ/cm2. Each setting was validated in 6 eyes for dissection parameters and compared to UCVA and contrast sensitivity to previous settings, if the new ones were better or the same, we proceeded to lower the dose further.
Results
From 750 mJ/cm2 to about 550 mJ/cm2 the results were very comparable, next day UCVA was on average 0.1 logMAR with contrast sensitivity recovering between week 3 and week 6 to baseline values. As we reached 494 mJ/cm2 there still no difficulty in dissection so as the standing confirmed world record was broken, we decided to explore this extreme low dose environment to better understand the effects of this dose range on the cornea. When we reached doses of 460 mJ/cm2 we started to get next day UCVA od 0.0 or better in all eyes with contrast recovering to bassline levels on day 1 for low to moderate myopia and week one for high myopia and astigmatic corrections.
Conclusion
The lowest dose of 292 was reached during this exploration but a sweet spot of 420 mJ/cm2 was found to offer the best ratio of ease of dissection, extraction time, next day UCVA and contrast sensitivity. We hope to encourage other surgeons and laser companies to explore lower dose regiment for their KLEx procedures to improve speed of recovery.
Presenting Author
Rohit Shetty, FRCS
Co-Authors
Pooja Khamar MD, PhD
Purpose
To describe and evaluate a novel Pressure-Exerted Easy Lenticule Rhexis (PEEL) technique for lenticule extraction in Smooth Incision Lenticule Keratomileusis (SILK�).
Methods
In this prospective, contralateral, randomized study, one eye of each patient undergoing SILK surgery had lenticule extraction performed using the traditional manual dissection method, while the other eye underwent the PEEL technique for lenticule removal. Subjective (Quality of Vision [QOV] questionnaire) and objective assessments of QOV were performed on postoperative days 1, 30, and 90. Keratocyte activation was evaluated on days 1 and 30 using confocal microscopy (Heidelberg Engineering GmbH, Heidelberg, Germany).
Results
A total of 240 eyes from 120 patients underwent SILK for correction of refractive errors. Patients who had lenticule extraction with the PEEL technique reported better subjective outcomes compared to those in the manual dissection group. Objective assessments also supported this, with the PEEL group showing a lower objective scatter index (OSI) of 0.94, 0.75, and 0.60 on days 1, 30, and 90, respectively, compared to the manual dissection group (1.58, 0.93, and 0.70 on the same days). Additionally, post-surgery keratocyte activation was lower in the PEEL group. Strehl�s ratio was higher in the PEEL group, indicating better postoperative QOV.
Conclusion
The PEEL technique appears to be a safer, more effective, and minimally invasive alternative to manual dissection, offering improved QOV in the early postoperative period.
Presenting Author
Aafreen Bari, MD
Co-Authors
Namrata Sharma MD, Tushar Agarwal MD, Tanuj Dada MD, Priyadarshini K MD
Purpose
To study the ablation pattern and outcomes in patients with hyperopic refractive error who underwent Femtosecond LASIK using Zeiss VisuMax femtosecond and MEL 90 excimer laser (Carl Zeiss Meditec, Jena, Germany).
Methods
A prospective case series was conducted at tertiary eye centre in India. The ablation pattern at the flap hinge was observed in 10 eyes of 5 consecutive patients who underwent femtosecond LASIK for hyperopic refractive correction (Preoperative Mean refractive spherical equivalent up to +6.50DS). This observation was also correlated with serial Anterior Segment Optical Coherence Tomography (ASOCT) examination and serial clinical photographs post-operatively.
Results
The mean BSCVA preoperatively was found to be 0.28�0.21 logMAR Snellen visual acuity. It was found that the excimer laser firing created an ablative pattern that included the hinge region of the flap partially with step-pattern of ablation at the hinge region in these eyes, causing a localised thinning of the flap. This pattern could also be documented better with an ASOCT, showing, a trough-like depression at the region of the hinge, which regressed in subsequent post-operative examinations. This also had an effect on the mean UDVA on day 1 postoperative day (0.5�0.38 logMAR), which improved gradually at 1 month post-operatively (0.3�0.2 logMAR), with the regressing step- configuration.
Conclusion
Hyperopic laser ablation might involve the hinge region which might result in suboptimal visual outcomes initially. However, this regresses with time, improving visual outcomes.
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