Transcript Medical Treatment of Myopic Regression after Refractive

Effects of IOP Lowering Agents on
Myopic Regression after Refractive
Surgery
Lim, Taehyung M.D., Hong, So Jin M.D., Cho, Beom Jin M.D., Ph.D.
Chung Kyu-Hyung M.D, Ph.D, Choi Kee-Yong M.D, Ph.D.
HanGil Eye Hospital
* All authors have no financial interest in the subject matter of this poster.
Background
Evidences of correlation between IOP and refractive error after LASIK
Factors affecting the forward shift of posterior corneal surface after
laser in situ keratomileusis.
Baek T, et al, 108(2):317-20, 2001, Ophthalmology
The higher IOP, the more anterior shifting of the cornea
Differences between regressive eyes and non-regressive eyes after
LASIK for myopia in the time course of corneal changes assessed with t
he Orbscan.
Pan, et al, 218(2):96-101, 2004, Ophthalmologica
Regressive eye vs. Non-regressive eye
differed in the corneal shifting movements after LASIK
Regression-related factors before and after laser in situ
keratomileusis.
Qi H. et al, 220(4):272-6,2006 Ophthalmologica
IOP lowering may prevent myopic regression.
Background
Evidences of correlation between IOP and refractive error after LASIK
Effects of antiglaucoma drugs on refractive outcomes in eyes
with myopic regression after laser in situ keratomileusis.
Kamiya K, et al, 145(2):233-238, Am J Ophthalmol, 2008
27 eyes with myopic regression after LASIK
Mean regression : 1.26±0.48D(-0.5 ~ -2.25D)
2.5 % Nipradilol bid for 3months
Pretreatment
3 Months
Spherical
-1.02±0.52D
-0.44±0.39D*
Astigmatism
-0.55±0.30D
-0.49±0.22D
IOP
11.4±2.4mmHg
9.1±8.2mmHg*
CCT
505.2±39.3um
505.6±38.7um
15% of patients did not respond to the treatment.
Background
Evidences of correlation between IOP and refractive error after LASIK
Effects of antiglaucoma drugs on refractive outcomes in eyes
with myopic regression after laser in situ keratomileusis.
Kamiya K, et al, 145(2):233-238, Am J Ophthalmol, 2008
It is suggested that backward movement of the cornea may occur,
possibly flattening the corneal curvature by lowering the IOP
Mean refractive power of
the total cornea (3mm)
Pretreatment
3 Months
38.4±2.0D
37.7±2.0D
Posterior corneal surface shifted posteriorly by 9.1±8.2um (mean)
Purpose
To evaluate effects of IOP lowering agents on patients who
have myopic regression after laser vision correction(LVC)
Methods
94 eyes in 47 patients (Male = 11 , Female = 36)
Op
PRK
LASIK
LASEK
Number
9
65
20
Mean age : 33.7 years (22~53)
Patients who have myopic regression after LVC
Occurrence of Myopic regression after LVC
: postoperative 4y5m ± 3y11m (1month ~ 12 years)
Methods
At the time of diagnosis, treatment was started with topical
0.5% timolol + 5% dorsolamide combination (Cosopt®, MSD, USA),
twice daily for 3 months.
Outcome parameters :
UCVA, BCVA, IOP, CCT, MR, Topography and ACD
f/u period : 1 week, 1 month, 3 months
Results
Pretreatment
Post-treatment
1 month
Post-treatment
3 months
Spherical error (D)*
-1.02±1.55
-0.50±1.27
-0.41±0.92
Astigmatism (D)
-0.23±0.78
-0.18±0.77
-0.18±0.67
IOP(mmHg)*
10.55±5.75
9.17±3.69
9.64±3.78
CCT(um)
486.9±95.1
486.9±95.1
481.6±109.1
ACD(um)
3.23±0.50
3.29±0.61
3.27±0.58
Keratometry(D)†
Anterior
Posterior
39.61±3.77
-6.43±0.64
38.36±3.94
-6.36±0.51
39.43±3.36
-6.41±0.55
* p < 0.05, paired T test
for pre-treatment & Post-treatment 3 months
† p < 0.05, paired T test
for pre-treatment & Post-treatment 1 month
Results
Pre-treatment
Post-treatment
1 month
Post-treatment
3 month
UCVA(logMAR)*
0.38±0.51
0.17±0.41
0.15±0.39
BCVA(logMAR)
0.01±0.06
0.01±0.07
0.01±0.08
* p < 0.05, paired T test
for pre-treatment & Post-treatment 3 months
Refractive error and UCVA changes through 3 months treatment
Refractive Improvement*
UCVA improvement
73.3%
87.5 %
* Refractive improvement :
manifest refraction error (spherical or cylindrical) improvement of more than 0.5D
Change of UCVA(LogMAR)
UCVA LogMAR
0.6
0.3
0.0
Pre-Tx
Post-Tx 1M
Post-Tx 3M
UCVA (LogMAR) improved significantly through 3 months treatment.(p<0.05)
Conclusion
• UCVA improved in 87.5% of patients much more
than that of refractive error improvement(73.3%).
• It is suggested that IOP lowering may induce the
change of corneal curvature, according to 1-month
result.
• IOP lowering agents may be helpful to reduce
myopic regression.
Discussion
• Although 3-month result showed no statistically
significant change in corneal curvature, it is still
though to be important mechanism that IOP
lowering may induce the change of corneal
curvature.
• Long term follow-up should be needed.
• We stopped the medication at 3 months and are
evaluating patients to confirm the effect and
mechanism.