Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneasmooth and still left significant stroma behind. Procedure 3 removedthe most stroma and in two cases left an almost bare DM behind, butthe edges of the resection were rougher than the other procedures.One case of perforation of DM occurred. There was no morphologicdamage to the endothelium.Conclusions: FS laser-created deep lamellar beds are not normally assmooth as < 120µm flaps, but the debulking and single or doubleraster passes can create smooth beds. The multiple raster passtechnique, dubbed the “Little Bubble Technique” was able to bareDM and remove the most stroma, but has the risk of perforation ofDM similar to the “Big Bubble Technique”. It appears to have a morepredictable depth resection and does not require mechanical airinjection. Modifications of SL, energy settings, side cut angles andside cut energy may be more predictable in baring DM.Commercial Relationships: Perry S. Binder, Abbott MedicalOptics inc. (C); Roger F. Steinert, Abbott Medical Optics (C),OptiMedica (C), ReVision Optics (C), WaveTec (C); James E. Hill,Abbott Medical Optics (E); Michael A. Campos, Abbott MedicalOptics (E)Program Number: 3138 Poster Board Number: D0073Presentation Time: 8:30 AM - 10:15 AMRefractive surgery evaluation and risk of corneal ectasia, interrateragreement and comparison to a new software: the SCOREanalyzerFlorence Cabot 1 , Sonia H. Yoo 1 , Alain Saad 2 , George Kymionis 3 , AnaPaula Canto 1 , Damien Gatinel 2 . 1 Ophthalmology, Bascom PalmerEye Institute, Miami, FL; 2 Ophthalmology, Rothschild Foundation,Paris, France; 3 Ophthalmology, University of Crete, Heraklion,Greece.Purpose: To assess the level of agreement between 5 refractivesurgeons and a new software in detecting corneal ectasia risk duringrefractive surgery evaluation.Methods: Retrospective multicenter study including 168 eyes of 84patients. Three attending ophthalmologists subspecializing inrefractive surgery and 2 cornea fellows reviewed 168 Orbscan(Bausch and Lomb, Rochester, NY) topographic quadmaps extractedfrom the Bascom Palmer Eye Institute refractive evaluation database.They rated the maps and determined whether a refractive surgery(Laser in situ keratomileusis [LASIK], or Photorefractivekeratectomy [PRK]) was advisable or not. Topographic maps weredivided in 3 different groups according to the followingclassification: LASIK or PRK (group 1), PRK only (group 2), Nosurgery (group 3). Only topographic indices were used to classify themaps. Age, daily activities, family history, symmetry between botheyes and refraction were not taken into account to rate the maps. Thesame maps were also screened by a new corneal ectasia risk detectionsoftware combined with the Orbscan: the SCORE analyzer(Technnolas Perfect Vision). Multirater kappa statistics were used toassess inter-rater agreement.Results: 43.1% and 58.9% of topographic maps were classified ingroup 1 ; 37.1% and 2.9% in group 3 by cornea fellows. 75,6% ,46.2% and 55% of topographic maps were classified in group 1 ;13.2% , 18.7% and 1.8% in group 3 by subspecialized attendingophthalmologists. 57.7% of topographic maps were classified ingroup 1 and 9.6% in group 3 by the SCORE analyzer (TechnolasPerfect Vision, Munich, Germany). Inter-rater agreement was slightto fair compared with that expected by chance: the overall rate ofagreement was 56% and the fixed marginal kappa coefficient was0.24.Conclusions: The inter-rater agreement between experiencedrefractive surgeons with different backgrounds is relatively low.Using the SCORE analyzer as an objective assessment in determiningthe patient’s candidacy for refractive surgery is valuable. Age,refraction, symmetry between eyes and family history are otherfactors that may be incorporated into the SCORE analysis in thefuture to make the assessment more robust.Commercial Relationships: Florence Cabot, None; Sonia H. Yoo,Alcon Labs (C), Carl Zeiss Meditec (C), Bausch and Lomb (C),Trascend Medical (C), Allergan (C), Optimedica (C), University ofMiami (P); Alain Saad, Acufocus (C); George Kymionis, None;Ana Paula Canto, None; Damien Gatinel, Technolas (C)Program Number: 3139 Poster Board Number: D0074Presentation Time: 8:30 AM - 10:15 AMThe effect of high order aberrations on the accuracy of wavefrontablations using LASEK on high myopesJeff G. Grigsby 1, 3 , Kathy Vasquez 3 , Michael Tschoepe 4, 3 , Thomas R.Walters 5, 3 , Billy Cook 2 , Robert G. Sheets 2 , Dennis K. Neely 2 .1 Redwine Research, LLC, Midland, TX; 2 VisionHealth Specialties,Midland, TX; 3 Eye LASIK Midland, Midland, TX; 4 RealEyes VisionCenter, New Braunfels, TX; 5 Eye LASIK Austin, Austin, TX.Purpose: LASEK is used to correct myopia, hyperopia, astigmatismand high order aberrations (HOA) such as coma, trefoil and sphericalaberration. It is unclear how these pre-operative HOA affect theaccuracy of the final refractive result in LASEK. Additionally,Teus,et al., 2007 proposed that LASIK nomograms may overcorrecthigh myopes receiving LASEK.Methods: A retrospective analysis of 113 eyes of 69 patients whohad LASEK performed between 2005-2010 using either a standard orCustomvue© ablation was performed. Subjects had at least -6.00diopters of sphere pre-operatively. The standard ablation grouputilizing physician adjustments included 63 eyes averaging -7.49 Dsphere and average astigmatism of -1.41 D. The Customvue©ablation group utilizing physician adjustments included 50 eyesaveraging -6.56 D sphere and average astigmatism of -0.63D. Theuse of intra-operative mitomycin C was slightly higher in thestandard vs. the Customvue© group (74% vs 54%), but was notdifferent between the pre-operative < 0.1000μ normalized polarZernicke coefficient (NPZE) and the > 0.1000μ NPZE Customvue©spherical aberration groups. Refractions were performed at 1, 3, 6and 12 mths post-operatively.Results: The mean spherical equivalent post-operative refraction wasnot significantly different between the two groups (standard groupmean +0.07 D, std. deviation 0.62 D; Customvue© +0.15 D, 0.58 D).When pre-operative physician adjustments were removed from finalCustomvue© refractive results, 32% of Customvue LASEK eyeswould have had a final result of ≧ ±0.50 D. 23 of the 50 eyes had apre-operative positive spherical aberration >0.1000μ NPZE. Withouta physician adjustment these 23 eyes would have been responsible for69% of the eyes with post-operative refractions ≥ ±0.50 D. Themeans were similar between the eyes with pre-operative sphericalaberration < 0.1000μ NPZE and those > 0.1000μ NPZE (-0.0136,0.0413 D), but the variances were significantly different (0.1388 vs.0.5681 D, p 0.1000μ NPZE puts the Customvue© patient athigher risk of enhancement unless adequately compensated with anappropriate physician adjustment.Commercial Relationships: Jeff G. Grigsby, None; KathyVasquez, None; Michael Tschoepe, None; Thomas R. Walters,None; Billy Cook, None; Robert G. Sheets, None; Dennis K. Neely,None©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.