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LASIK & LASEK for LASIK & LASEK for Residual Refractive Residual Refractive Errors After Refractive Errors After Refractive Lens Exchange Lens Exchange Ruth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt, Ruth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt, Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Maarten Mourits, MD, PhD Maarten Mourits, MD, PhD 1. 1. Retina Total Eye Care, Driebergen. Retina Total Eye Care, Driebergen. 2. 2. Dept. of Ophthalmology, Academic Medical Center, Dept. of Ophthalmology, Academic Medical Center, Amsterdam Amsterdam The Netherlands The Netherlands [email protected] R. Lapid has received speakers and R. Lapid has received speakers and Advisory board fees from Alcon, and an Advisory board fees from Alcon, and an unrestricted research grant from Oculentis. unrestricted research grant from Oculentis. The other authors have no financial interest. The other authors have no financial interest.

LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

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LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange. Ruth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt, Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Maarten Mourits, MD, PhD Retina Total Eye Care, Driebergen. - PowerPoint PPT Presentation

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Page 1: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

LASIK & LASEK for Residual LASIK & LASEK for Residual Refractive Errors After Refractive Errors After

Refractive Lens ExchangeRefractive Lens ExchangeRuth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt, Ruth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt,

Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Maarten Mourits, MD, PhDMaarten Mourits, MD, PhD

1.1. Retina Total Eye Care, Driebergen.Retina Total Eye Care, Driebergen.2.2. Dept. of Ophthalmology, Academic Medical Center, AmsterdamDept. of Ophthalmology, Academic Medical Center, Amsterdam

The NetherlandsThe [email protected]

R. Lapid has received speakers and R. Lapid has received speakers and Advisory board fees from Alcon, and anAdvisory board fees from Alcon, and an

unrestricted research grant from Oculentis. unrestricted research grant from Oculentis. The other authors have no financial interest.The other authors have no financial interest.

Page 2: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Bioptics: LASIK or LASEK after a Bioptics: LASIK or LASEK after a lenticular intra-ocular procedurelenticular intra-ocular procedure

After RLE small refractive errors can cause After RLE small refractive errors can cause significant complaints of VAsignificant complaints of VA

No consensus for RLE or bioptics.No consensus for RLE or bioptics.

What is the minimal refractive error or the What is the minimal refractive error or the minimal loss of lines on UDVA to consider minimal loss of lines on UDVA to consider a corneal laser procedure?a corneal laser procedure?

Page 3: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

BiopticsBioptics

1.1. Surprise in post-Restor SE or VASurprise in post-Restor SE or VA2.2. Planned bioptics for pre-op corneal Planned bioptics for pre-op corneal

astigmatismastigmatism

Prospective case series.Prospective case series.Single surgeon (RLG) for RLE and biopticsSingle surgeon (RLG) for RLE and biopticsLASIK: XP microkeratome 120 micron flaps LASIK: XP microkeratome 120 micron flaps

(Technolas)(Technolas)LASEK: 30 sec 20% alcoholLASEK: 30 sec 20% alcoholLaser platform: Technolas z217 PlanoscanLaser platform: Technolas z217 Planoscan

Page 4: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

DemographicsDemographics

45 eyes of 26 patients45 eyes of 26 patients

Mean age 58.9 (range:51.5 - 66.17 years)Mean age 58.9 (range:51.5 - 66.17 years)

80.7% males80.7% males

27 eyes LASEK, 18 eyes LASIK 27 eyes LASEK, 18 eyes LASIK

Hyperopes 22 eyes, myopes 23 eyesHyperopes 22 eyes, myopes 23 eyes

Page 5: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Pre-operative data:Pre-operative data:

LASIK LASEK

18 # eyes 27

57.1(51.5-63) Age (range) 60.1(54.5-66.2)

0.50 + 0.72 (-1.875 +1.25) Pre-op SE 0.34D + 0.73D (-0.75 +1.5)

1.21+0.62 (+0.75- +1.50) Pre-op sphere 1.09 + 0.2 (-0.25 +2.5)

-1.01+0.62 (0- -2.25) Pre-op cylinder -1.44 + 0.59 (-0.5 – 2.75)

0.63+0.2 (0.32-0.9) Pre-op UDVA 0.58 + 0.19 (0.32-0.8)

1.1+0.16(0.9-1.5) Pre-op CDVA 1.05 + 0.17 (0.7-1.25)

0.96+0.09 (0.8-1.0) Pre-op UNVA 0.96 + 0.23 (0.8-1)

191 d+ 62d (125-362 days) Mean time from RLE

175 d + 70d (84-364)

Page 6: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Post-operative data LASIK:Post-operative data LASIK:

LASIK 3months 6months

# eyes 18 14 (4 eyes lost to follow up)

Efficacy D 0.98 1.03

Safety D 1.07 1.10

Efficacy N 1.01 1.03

Mean UCDA 1.08 (20/19) 1.13 (20/17)

Post op SE 0.29D + 0.34D (-0.25 +1.00)

0.10D + 0.23 (-0.25 to +0.625)

Post op Sphere

0.43 + 0.33 (0 +1.25) 0.23 + 0.75 (0 +0.75)

Post op Cylinder

-0.30 + 0.39 (0 -1.00) -0.25 + 0.39 (0 -1.00)

Page 7: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Post-operative data LASEKPost-operative data LASEKLASEK 3 months 6 months

# eyes 27 24 (3 eyes lost to fu)

Efficacy D 0.94 1.08

Safety D 1.06 1.12

Efficacy N 1.03 1.01

Mean UCDA 0.99 (~20/20)0.99 (~20/20) 1.13 (20/17)

Post op SE 0 + 0.5D (-0.625 +0.625) -0.06 + 0.22D (-0.62 to +0.62)

Post op Sphere 0.17 + 0.50 (-0.25 +1.25)

0.04 + 0.23 (-0.25 to +0.75)

Post op Cylinder

-0.32 + 0.42 (0 -1.25) -0.20 + 0.28 (0 to -0.75)

Page 8: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Attempted versus achieved Attempted versus achieved sphere & cylinder correction after sphere & cylinder correction after

LASIK & LASEK after RLELASIK & LASEK after RLE

0

0.5

1

1.5

2

2.5

3

0 0.5 1 1.5 2 2.5 3

Attempted correction

Ach

ieve

d c

orr

ecti

on

lasek 3 months

lasik 3 months

0

0.5

1

1.5

0.00 0.50 1.00 1.50

Attempted correction

Ach

ieve

d c

orr

ecti

on

lasik cyl correction

lasek cyl correction

Bot h graphs show mostly good congruency between attempted and achieved corrections. In the sphere corrections deviations from target were mostly undercorrections. With the cylinder corrections the deviations from target were more spread out.

Page 9: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Safety and predictabilitySafety and predictability at 3 and 6 months: at 3 and 6 months:

Lines gained and lost at 3 & 6 m

0%

20%

40%

60%

80%

100%

<-2 -1 0 1 >+2

lines

%

lasik 3m

lasik 6m

lasek 3m

lasek 6 m

0%

20%

40%

60%

80%

100%

120%

within 0.25 D within 0.5 D within 1.0 D

lasik 3 m

lasik 6 m

lasek 3 m

lasek 6 m

Safety: we see that most patients did not loose or even gained lines.Loos of lines at 3 months was dueTo a residual refractive error.

Efficacy: All were within 1.0D of Target refraction, at 6 months wesee that close to 90% are within0.5D of target refraction.

Page 10: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Snellen VA before and after LASIK Snellen VA before and after LASIK and LASEK in multifocal RLEand LASEK in multifocal RLE

0%

20%

40%

60%

80%

100%

<0.5 0.63 0.8 1 1.25 1.6

pre-opUDVA

pre-op CDVA

pre-op UNVA

3 m UDVA

3m CDVA

3m UNVA

h

0%

20%

40%

60%

80%

100%

<0.5 0.63 0.8 1 1.25 1.6

pre-opUDVA

pre-op CDVA

pre-op UNVA

3 m UDVA

3m CDVA

3m UNVA

Snellen VA pre-op (blue hues) versus post-op (red hues)

LASIK

LASEK

Snellen lines

Snellen lines

Page 11: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

LiteratureLiterature

Piñero DP, Espinosa MJ, Alió JL, J Refract Piñero DP, Espinosa MJ, Alió JL, J Refract Surg. 2009 Nov 11:1-9Surg. 2009 Nov 11:1-9

Good outcomes. Especially in myopes. Different types of Good outcomes. Especially in myopes. Different types of multifocal IOL’s used and did not mention whether standard multifocal IOL’s used and did not mention whether standard or wavefront treatment was usedor wavefront treatment was used

Muftuoglu et al, JCRS June 2009, p.1063-1071Muftuoglu et al, JCRS June 2009, p.1063-1071Similar results in cataract patients with multifocal implants.Similar results in cataract patients with multifocal implants.

Both standard tx and wavefront. Five different surgeons.Both standard tx and wavefront. Five different surgeons.

Femtosecond laser used to create flap. No data on LASEK.Femtosecond laser used to create flap. No data on LASEK.

Page 12: LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

Conclusion:Conclusion:

Bioptics for small refractive errors is Bioptics for small refractive errors is predictable, effective, and safe. predictable, effective, and safe. RLE patients are very demandingRLE patients are very demandingMultifocal toric will possibly decrease the Multifocal toric will possibly decrease the need for bioptics need for bioptics Wait with performing corneal laser Wait with performing corneal laser procedure for post RLE tearfilm procedure for post RLE tearfilm stabilizationstabilizationYAG capsulotomy in our clinic is done on YAG capsulotomy in our clinic is done on indication onlyindication only