Transcript PRK in PPMD - ASCRS/ASOA 2010

Photorefractive Keratectomy in Posterior
Polymorphous Dystrophy
[CONTROL ID: 735066]
Edward W. Trudo1, Kraig S. Bower2, Charles D. Coe2, Denise A. Sediq2,
Jennifer Eaddy2, Chrystyna P. Kuzmowych2, Rose Kristine C. Sia2
1
Ophthalmology Service, Keller Army Community Hospital, US Military Academy, West Point, NY
2 Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC
The authors do not have any financial interests or relationships to disclose.
The views expressed in this poster are those of the authors and do not reflect the official
policy of the Department of the Army, Department of Defense, or the U.S. Government.
Purpose
• A previous study reported results in Posterior
Polymorphous Dystrophy (PPMD) patients
undergoing LASIK but there is no such report
of results following PRK. [1] The purpose of
the present study is to report safety and
efficacy of PRK in patients with PPMD.
1: Moshirfar M, Barsam CA, Tanner MC. Laser in situ keratomileusis in patients with
posterior polymorphous dystrophy. Cornea 2005 Mar;24(2):230-2.
Methods
• We reviewed clinical records of patients with clinical
features of PPMD who underwent PRK between June
2005 and November 2008.
• Pre- and post-op results were compared using a paired Ttest and p < 0.05 was considered statistically significant.
• Data for analysis included gender, age, ablation depth
(AD), surgical complications, manifest spherical
equivalent (MSE), uncorrected visual acuity (UCVA), best
spectacle-corrected visual acuity (BSCVA), intraocular
pressure (IOP), central corneal thickness (CCT),
endothelial cell density (ECD), and post-op complications.
Results
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12 eyes/6 patients
Mean age 30.5 +/- 9.2 years (range 21-42 yrs)
6 Male/0 Female
Mean f/u 533.7 days (range 189 to 1233 days)
MSE: -4.07 +/- 1.44D (range -1.88D to -6.25D)
CYL: 0.40 +/- 0.30D (0 to 1.00D)
IOP: 13.9 +/- 3.4 mmHg (10 to 19 mmHg)
CCT: 560.8 +/- 54.4µ (481 to 645µ)
AD: 59.91 +/- 20.91 (30.6 to 84.2)
ECD: 2826.5 +/- 285.0 c/mm2 (2122 to 3054)
UCVA – POSTOPERATIVE
100.0% 100.0% 100.0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100.0% 100.0% 100.0% 100.0%
83.3%
33.3%
0.0%
20/15
20/20
20/25
20/30
20/40
<20/40
UCVA (Cumulative) 1 month (N=12)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
66.7%
0.0%
20/15
20/20
20/25
20/30
20/40
<20/40
UCVA (Cumulative) 3 months (N=12)
UCVA – 6M and 12M
100.0% 100.0% 100.0% 100.0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100.0% 100.0% 100.0% 100.0%
91.7%
0.0%
20/15
20/20
20/25
20/30
20/40
<20/40
UCVA (Cumulative) 6 months (N=12)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
91.7%
0.0%
20/15
20/20
20/25
20/30
20/40
<20/40
UCVA (Cumulative) 12 months (N=8)
BSCVA – 3M and 6M Post-op
66.7%
70%
75.0%
80%
60%
70%
50%
60%
50%
40%
40%
30%
16.7%
20%
10%
25.0%
30%
16.7%
20%
0.0%
0.0%
0%
10%
0.0%
0.0%
0.0%
-1 lines
-2 lines
0%
+2 lines +1 lines
0 lines
-1 lines
-2 lines
Change in BSCVA 3 months (N=12)
+2 lines +1 lines
0 lines
Change in BSCVA 6 months (N= 12)
BSCVA – 12M Post-op (N=8)
75.0%
80%
70%
60%
50%
40%
25.0%
30%
20%
10%
0.0%
0.0%
0.0%
-1 lines
-2 lines
0%
+2 lines
+1 lines
0 lines
Change in BSCVA
MSE Stability Post-op-----------------------IOP after PRK (mmHg)
Spherical equivalent (D)
16
14
0.50
12
-0.50
-1.50
Preop
1M
3M
6M
12M
10
8
6
-2.50
-3.50
-4.50
4
2
0
Preop
1M
3M
6M
12M
Endothelial Cell Analysis (n=8)
Corneal
Pre-Op
Post-OpD
Difference
Endothelium
Mean
SD
Mean
SD
P-valueE
ECDA
2,945.3
93.7
2,991.3
348.7
0.35
PleomorphismB
54.87
9.81
52.24
9.68
0.29
PolymegathismC
38.92
7.06
41.27
15.45
0.21
Notes:
A Endothelial cell density (cells/mm2); normal range 2,056 to 3,594
B Percentage of cells outside normal range above; normal < 30%
C Percentage of six-sided cells; normal > 59.6%
D Final post-op visit, mean 404 days (range 189 to 564 days)
E Paired T-test (P<0.05 significant)
Central Corneal Thickness (n=12)
CCTA
Pre-Op
Post-OpB
Change
ADC
P-ValueD
Mean
560.8
494.8
65.9
63.6
0.33
SD
54.4
77.3
31.4
20.1
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Notes:
A Central corneal thickness (µ)
B Final post-op visit, mean 533 days (range 189 to 1,233 days)
C Ablation depth (µ)
D Paired T-test, comparing change in CCT vs. predicted AD (P<0.05 significant)
Conclusions
• This retrospective review of 6 patients with PPMD,
demonstrated the safety and efficacy of PRK with
excellent UCVA, retention of BSCVA, and low
incidence of adverse effects.
• Post-operative endothelial cell density and cell
morphology did not change significantly from
baseline.
• PRK appears safe and effective in the short term in
this small sample size of PPMD patients, additional
study is necessary to determine the long term effects
of PRK on this subset of patients.