Transcript Refractive effects of office based Lamellar Keratectomy

Refractive Effects of Lamellar
Keratectomy/Debridement for Corneal
Surface Disorders Pre-Cataract Surgery
Haresh Ailani MD,1 Ira J. Udell MD,1
Jules Winokur MD2
1. North Shore-Long Island Jewish Department of Ophthalmology, Albert Einstein College of Medicine
2. Illinois Eye and Ear Department of Ophthalmology
PURPOSE
• The purpose of this study was to evaluate visual
improvement with Office Based Lamellar Keratectomy/
Debridement (OBLKD) for treatment of visually
significant anterior basement membrane dystrophy
(ABMD) in patients prior to cataract or refractive surgery.
OBLKD can be used to treat these disorders and can result
in reduced irregular astigmatism and visual distortion.
• In patients undergoing CE or refractive surgery, OBLKD
may allow for more effective measurements of refractive
error and keratometry. Demonstrate a quantitative and
qualitative change in vision using refraction data and
corneal topography
METHODS
Retrospective case series review of 11 patients
undergoing 14 procedures that presented to a cornea
practice from Jan 2000- Jan 2007. Only patients that
underwent OBLKD for visually disturbing
symptoms were included in the study. Data recorded
included pre and postoperative best corrected visual
acuity, manifest refraction, and visual symptoms.
Primary outcome measures were mean best corrected
logMAR acuity and change in refractive error.
OFFICE BASED LAMELLAR
KERATECTOMY/DEBRIDEMENT
• Topical anesthetic and one drop NSAID applied
prior to procedure.
• Epithelial debridement performed using 15 blade.
• Deep lamellar basement membrane stripping was
performed to achieve smooth stromal surface.
• Selected specimens were formalin fixed and sent
for pathology.
REPRESENTATIVE CASE 1
70 yo Male
Cataracts OU, ABMD OU,
prior Debridement OD
BCVA OS– 20/40
Man Rx: -2.00 +3.00 @165
K: 45.0, 41.0 @ 99
Debridement OS
BCVA – 20/25
Man Rx:-2.75 +2.25 160
K: 43.5, 41.75 @ 79
F/U : Va improved and decided
to postpone cataract surgery
REPRESENTATIVE CASE 2
68 yo Female
ABMD OU
BCVA OD– 20/50
Man Rx: -5.25
K: 42.5, 42.0
Debridement OD
BCVA – 20/25
Man Rx: -4.25
K: 42.75, 42.0
F/U : Pt reports “better
clarity, less distortion”
RESULTS
The mean age of patients was 75.2 years. 64% were female.
13 out of 14 eyes showed improvement in BCVA. One case
demonstrated no change in Snellen acuity, however reported
improved subjective acuity and less visual distortion. Mean
BCVA improved from 20/70 to 20/45 or 0.21 logMAR units,
range: 0 - 0.36 units (p value = .005). Mean change in
spherical equivalent was 0.25 D (range: -3.25 D to 2.75 D).
In addition, mean change in cylinder was 0.23 D (range: -0.5
D to 1.50D). Two out of 13 patients s/p OBLKD deferred
cataract surgery secondary to improved acuity.
RESULTS
Change in Spherical Equivalent
4
2
Diopters
0
1
2
3
4
5
6
7
8
-2
-4
-6
-8
Pre Op SE
Post Op SE
-10
Patients
9
10
11
12
13
14
CONCLUSIONS
OBLKD improved BCVA by approximately 2
lines of Snellen acuity (statistically
significant). In addition, patients reported
significantly reduced visual distortion.
OBLKD can reduce irregular astigmatism and
may result in significant refractive error
changes. Prior to cataract or refractive
surgery, patients with ABMD should be
considered for OBLKD.