Cornea - ARVO

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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneafollowing deep anterior lamellar keratoplasty (DALK).Methods: All patients that had PRK for residual myopia, hyperopiaand astigmatism following DALK between January 2008 to October2012 were included in this study. Mitomycin C (MMC) was appliedin all cases. The uncorrected distance visual acuity (UDVA),corrected distance visual acuity (CDVA), manifest refraction, cornealtopography, early and late complications were assessed.Results: The study included 13 eyes of 13 patients. Nine patientswere male and four patients were female. Mean age was 41.3 ± 18.4years (Mean ± SD). The indications for DALK were: keratoconus (7eyes), post-infectious scar (4 eyes), post-laser scar (1 eye), and postradial keratotomy (1 eye). Six patients underwent intralase enabledDALK (IE-DALK). The mean period between the DALK and PRKwas 27.4 ±12.7 months. The preoperative UDVA was 0.88 ± 0.53logMAR. The preoperative mean CDVA was 0.20 ± 0.18 logMARand the mean spherical equivalence (SE) was -2.65 ± 5.00 diopters(D). The mean follow up after PRK was 12.5 ± 11.7 months. At thefinal visit, the mean UDVA was improved to 0.23 ± 0.25 logMAR (P= 0.001). The mean CDVA was 0.17 ± 0.22 logMAR (P = 0.57), andthe mean final SE was -0.05 ± 1.41 D (P = 0.069). Astigmatismtended to be decreased from -3.27 ± 1.76 D preoperatively to -0.94 ±0.49 D postoperatively (P=0.001). UDVA improved more than twolines in 11 eyes (84.6%). One eye (7.7%) had one line improvementof UDVA and one eye (7.7%) had no improvement. All eyes hadcomplete epithelization within 5 days after procedure. Mild cornealhaze without significant visual reduction was presented in 4 eyes(30.8%). One eye had corneal epithelial rejection at 6 months afterPRK with MMC which resolved after treatment with topical steroids.Conclusions: Using PRK with MMC for the treatment of residualrefractive error after DALK lead to improvement in uncorrectedvisual acuity and can be considered as an acceptable treatmentmodality to improve quality of vision following DALK.Commercial Relationships: Pichaporn Artornsombudh, None;Yakov Goldich, None; Noa Avni-Zauberman, None; Uri Elbaz,None; Setareh Ziai, None; David Rootman, AMO (F)Program Number: 3124 Poster Board Number: D0059Presentation Time: 8:30 AM - 10:15 AMComparison of the Ocular Response Analyzer and the Belin-Ambrósio Ectasia Display for Detecting Eyes at High Risk ofDeveloping Ectasia After Refractive SurgeryMaria Eugenia Vola Ravina 1 , Renato Lisboa 1 , Patricia Schimchak 3 ,Kody J. Kishi 2 , Natalie A. Afshari 1 , David J. Schanzlin 4 .1 Ophthalmology, University of San Diego California, La Jolla, CA;2 University of Calgary, Calgary, AB, Canada; 3 Cornea, CETAO,Montevideo, Uruguay; 4 Gordon-Weiss-Schanzlin, La Jolla, CA.Purpose: To compare diagnostic accuracies of the Ocular ResponseAnalyzer (ORA) and the Belin-Ambrósio Ectasia Display (BAD)with the Randleman Ectasia Risk Score (RS) in eyes undergoingrefractive surgery.Methods: Two hundred and forty-nine eyes of 136 myopic patients,with no previous ocular surgery evaluated for refractive surgery wereincluded in the study. Before surgery, all eyes underwent a clinicalexamination and evaluation with Pentacam (Oculus, Wetzlar,Germany) and ORA (Reichert, Buffalo, NY). We calculate the RS forall eyes as if a laser in situ keratomileusis with a hypothetical 150 μmflap would be performed. Eyes with a RS ≥ 4 were considered tohave a high risk of post-operative ectasia. Parameters included in theanalysis from the ORA were keratoconus match index (KMI), cornealhysteresis (CH), and corneal resistance factor (CRF). Parametersfrom the BAD provided by the Pentacam included in the analysiswere anterior elevation change (DF), posterior elevation (DF),pachymetric progression (DP), absolute thinnest point (DT),displacement of the thinnest point (DY), and combined index (D).These “D values” represent the standard deviation from an internaldatabase of healthy eyes. Areas under the receiver operatingcharacteristic curves (AUC) were calculated to summarize thediagnostic accuracy of each parameter. Logistic regression wasperformed for the best parameter in order to access the magnitudeand direction of the association with the RS.Results: Eighty-seven eyes with a RS ≥ 4 were included in the groupwith a high risk of ectasia, whereas 162 eyes with a RS < 4 wereincluded in the control group. The ORA parameter with the largestAUC was the CRF (0.68 ± 0.05), followed by CH (0.65 ± 0.05) andKMI (0.64 ± 0.04). The BAD parameter with the largest AUC wasthe DT (0.80 ± 0.04), followed by the D (0.64 ± 0.05), and the DY(0.62 ± 0.05). DT provided by the BAD performed significantlybetter than CRF provided by the ORA (0.80 vs. 0.68; P = 0.003).Each 1 mmHg of decrease in the CRF was associated with a 46%increase in the odds of presenting a high risk in the RS.Conclusions: The absolute thinnest point provided by the BAD fromthe Pentacam performed better than the CRF from the ORA indetecting patients at a high risk of postoperative corneal ectasia.Larger studies may help to confirm these preliminary findings.Commercial Relationships: Maria Eugenia Vola Ravina, None;Renato Lisboa, None; Patricia Schimchak, None; Kody J. Kishi,None; Natalie A. Afshari, None; David J. Schanzlin, RefocusGroup (C), Oasis Medical (C)Program Number: 3125 Poster Board Number: D0060Presentation Time: 8:30 AM - 10:15 AMVisual Performance Comparison of Wavefront-optimized andWavefront-guided Laser in situ keratomileusis (LASIK)Kraig S. Bower 1 , Lamarr Peppers 2 , Rose K. Sia 2 , Richard D.Stutzman 3 , Joseph F. Pasternak 3 , Denise S. Ryan 2 , Edward W.Trudo 2 . 1 Ophthalmology, Wilmer Eye Institute, Lutherville, MD; 2 USArmy Warfighter Refractive Surg Research Ctr, Fort BelvoirCommunity Hospital, Fort Belvoir, VA; 3 Ophthalmology, WalterReed National Military Medical Center, Bethesda, MD.Purpose: To compare visual acuity and contrast sensitivity resultsafter wavefront-guided (WFG) and wavefront-optimized (WFO)LASIK.Methods: This was a prospective randomized study that comparedvisual acuity (VA) and contrast sensitivity (CS) before and aftereither WFG (n=18) or WFO (n=17) LASIK. Subjects were matchedfor preoperative refractive error (mean spherical equivalent = -3.28±1.33D) and age (31.6 ±8.1 years) WFG surgeries were performedusing the VISX Star S4 (Abbott Medical Optics) and WFO surgerieswith the Wavelight Allegretto Wave Eye-Q (Alcon Surgical).Corneal flaps were created using the Intralase femtosecond lasersystem (Abbott Medical Optics). Best corrected VA and small letter(20/25) CS were measured with the Super Vision back-illuminatedletter chart (PrecisionVision®; PV) and low luminance, night visionassessed with the PV 25% Low Contrast Chart viewed through a darkgreen night vision filter. Measurements were obtained at baseline andat 1, 3 and 6 months postoperatively. Repeated measures ANOVAwas used to compare WFO vs. WFG LASIK over time.Results: There was no significant difference in ablation depth (WFG:49.9 ±11.9µ; WFO 57.6 ±21.7µ; p=0.20). All subjects retainedexcellent high contrast VA (20/16) with no difference between WFGand WFO, while CS improved slightly in the WFG group (p
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaWFO LASIK in terms of night vision performance and low contrastacuity.(1:5,970). This is similar or lower than previous reports (1:1,000 to1:5,000). While there were relatively few microbial cases, severalassociations were observed and include male gender (1:4,429),preoperative myopia (1:5,501), undergoing a surface ablationprocedure (1:3,161) and the use of a mechanical keratome for theLASIK flap creation (1:3,938).Commercial Relationships: Steven C. Schallhorn, AMO (C),Allergan (C); Julie M. Schallhorn, None; Adenay Padilla, NoneTable 1. Acuity and Contrast means± SD. P
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