Transcript Prezentacja programu PowerPoint

BIEL-MED SP. Z O.O.,
SZPITAL POD BUKAMI,
BIELSKO-BIAŁA, POLAND
THE EBK PROCEDURE FOR
CORRECTION OF REFRACTIVE ERRORS
AUTHORS:
IWONA ROKITA-WALA
MAJCHROWICZ MONIKA
THE AUTHORS HAVE ANY FINANCIAL INTEREST IN THE SUBJECT MATTER OF THIS PRESENTATION
EPIC-BOWMAN KERATECTOMY (EBK) is a new refractive
surgery technique, which consists of corneal epithelium
removing with Epi-Clear system and photoablation with Excimer
Laser
The EBK procedure leaves Bowman's layer completely intact
and prepares the ideal treatment zone for laser photoablation.
It seems that this method is safer, less expensive and more
comfortable for patients than conventional methods that have
been used so far
PURPOSE The purpose of the
study was to evaluate the clinical
results of EBK correction
of refractive errors
METHOD
The material consisted of 47 eyes of 24 patients
who had undergone for myopic and hyperopic correction using the EBK procedure that
was performed using the Epi-Clear (Orca Surgical, Ashkelon, Israel).
This is a dynamic epikeratome – system designed for epithelium removal.
Spherical equivalent range: -175 to 8.0D and +1.5 to +4.5D.
A NUMBER OF PATIENTS TREATED
24
A NUMBER OF EYES TREATED
47
PATIENTS’ AGE SPAN (YEARS)
21-41
PATIENT’S AVERAGE AGE (YEARS)
27,5
Surface ablation was followed by excimer laser Allegretto Wave, 400- Hz
(Alcon Laboratories, Inc.) in all eyes. Following the procedure, soft bandage contact
lenses were placed over the cornea and antibiotic, artificial tears drops, local nonsteroid anti-inflammatory agents as well as steroid were applied.
The evaluations were performed on the first postoperative day and then in 2, 3 days, 2
weeks and 2 months following the EBK surgery. The comparison of the best
postoperative uncorrected visual acuity (UCVA) to the preoperative best-corrected
visual acuity (BCVA) with spectacles assessed the efficacy of the method. The corneal
reshaping with videokeratography was followed up. The state of the cornea:
re-epithialization (measure with head of 9 mm marker-device), subjective symptoms,
pain (1-4 levels score) and haze were taken into consideration.
RESULTS
VISUAL ACUITY : In all of the cases postoperative UCVA was equal to the preoperative
BCVA, or even better in 8 eyes, starting from the 3rd day after the procedure.
Significant statistical data (p= 0.0107)
Visual acuity before procedure [Snellen]
0.7 – 1.0
Average value of visual
acuity
0,97
Visual acuity one day after procedure [Snellen]
0.5 - 0.9
0,64
0,11
Visual acuity two days after procedure [Snellen]
0.4 – 0.9
0.55
0.12
Visual acuity three days after procedure [Snellen]
0.9 - 1.0
0.99
0.01
Visual acuity two weeks after procedure [Snellen]
0.9 - 1.0
0.99
0.01
Visual acuity two months after procedure [Snellen]
0.9 – 1.0
0.99
0.01
Visual acuity
Average value of visual acuity
[ Snellen]
Change in the average value of visual acuity before
and after the procedure
Comparison of average visual acuity before
procedure and three days after
1.2
1
Standard
deviation
0.07
1.2
0.99
0.94
0.99
0.99
0.8
0.97
0.99
Average of visual acuity before
procedure
Average of visual acuity 3 days
after procedure (end of healing
process)
0.8
0.64
0.55
0.6
1
0.6
0.4
0.4
0.2
0.2
0
0
before
1 day after 2 days after 3 days after 2 weeks
after
2 months
after
RESULTS
VIDEOKERTOGRAPHY:
The reshaping changes of corneas
according to refractive error-removal
by videokeratography were detected.
HEALING PROCESS:
The state of the cornea- re-epithialization
Comparing diameters of epithelial-free
zone (EFZ) in the first and second day
after procedure
On the 3rd day, re-epithelialization
was complete in all eyes
POST-MYOPIC CORRECTION
Average
diameter EFZ
[mm]
Standard
deviation
4.54
0.50
0.95
0.06
First day after
procedure
Second day
after procedure
Average of valude diameter EFZ [mm] on
first and second day after procedure
5
4.54
[mm]
4
3
2
0.95
1
POST-HYPEROPIC CORRECTION
0
first day after
second day after
RESULTS
DISCOMFORT:
on the 1st or 2nd postoperative day, the patients reported discomfort and pain which was,
however, less severe (1st to 2nd level of score) in case of all patient
Discomfort on the first day after procedure
MEDIUM
LOW
58
%
42
%
Assessment of discomfort on
the first day after procedure
High discomfort
Severe discomfort
Medium discomfort
Low discomfort
No discomfort
Scale
A number of persons
A percentage number of persons
4
3
2
1
0
0
0
14
10
0
0
0
58%
42%
0
MEDIUM
Discomfort on the second day after procedure
13%
NONE
LOW
33%
54%
Assessment of discomfort
on the second
day after procedure
0
1
2
3
4
No discomfort
Low discomfort
Medium discomfort
Severe discomfort
High discomfort
High discomfort
Severe discomfort
Medium discomfort
Low discomfort
No discomfort
First day after
Second day after
Scale
4
3
2
1
0
A number of persons
0
0
3
13
8
A percentage number of persons
0
0
13%
54%
33%
Average evaluation of discomfort by patients in the scale from
0 to 4
Standard deviation
1.58
0.79
0.50
0.66
HAZE We did not observe haze during follow up in any
examined patients
CONCLUSION:
Among the methods used for correction of refractive errors, EBK is a safe method and more
comfortable for patients, which facilitates the healing process, and is characterized by
minimum pain sensation