Femtosecond laser assisted intrastromal corneal ring segment implantation for post-lasik corneal ectasia

Dominique PIETRINI, MD Tony GUEDJ,OD,ORTH Clinique de la Vision, Paris.

[email protected]

Financial disclosure: Dr D. Pietrini is a paid consultant for Mediphacos Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Materials and Methods

• 13 eyes with post lasik ectasia, follow up 6 months to 4 years.

• Mean age 38 years • Initial surgery – Microkeratome 80% Femtosecond 20% – Time between lasik ands ICRS 3 years – Form frust keratoconus in 8 cases / Insufficient stromal bed 2 cases / unkown etiology or association remaining cases • ICRS femtosecond implantation all cases • 3 eyes implanted with Intacs (Addition technology) • 10 eyes implanted with Kerarings (Mediphacos) • Interest of OCT for corneal evaluation • Mean flap thickness 148µm +/- 16.5µm (120/200) • Mean residual stromal bed 294µm +/- 55.1µm (210/400) Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Evolution of spherical equivalent and refractive cylinder

Spherical equivalent and refractive cylinder

6 5 1 0 4 3 2 -3,46D -2,04D -4,81D -2D spherical equivalent refractive cylinder Pre Op Post Op

N=13

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Evolution of uncorrected and best corrected visual acuity

9 8 7 2 1 0 6 5 4 3 1,8

UCVA and BCVA

6,75 5,46 8,23

UCVA Mean gain 5 lines BCVA Mean gain 3 lines

UCVA Pre Op Post Op BCVA

p<0.05

N=13

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Keratometric measurements Orbscan readings

60 50 40 30 20 10 0 45,84D 42,66D 52,21D 47,64D

Mean K reduced by 3D Kmax reduced by 4.6D

Kmean Pre Op Post Op Kmax Topo

p<0.05

N=13

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Corneal astigmatism

Corneal astigmatism

7 6 5 4 3 2 1 0 -5,85D -3,3D Corneal astigmastism Pre Op Post Op

N=13

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

High Order Aberration

2 1,5 1 0,5 0 -0,5 -1

HOA Rms showed a reduction of 59% after 2years for Two eyes Vertical Coma showed a reduction of 69% after 2years for Two Eyes HOA Rms (µm)

3 2,82 2,55 2,5 1,68 1,4 1,17 HOA rms Pre Op 0,81 0,86 0,79 V.Coma

Post Op 1month H.Coma

0,2 0,16 0,46 0,39 Z400 -0,27 -0,22 -0,64 -0,49 Post Op 6months Post Op 2years

N=2

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Case Report M. A.B,Man, 33 years old Post lasik ectasia: Marginal pellucid corneal dystrophy

KERATOMETRY: ASTIGMATISM: PACHYMETRY: UCVA: BCVA: REFRACTION:

LEFT EYE PRE OP

38.4D /43.7D 3 ° 5.3D

401µm

1 Week after KERARING IMPLANTATION

38.2D/40.9D 175 ° 2.7D

414µm 0.5 Log mar (3/10) 0.0 Log mar (10/10F) +1,75 (-4,50)85 ° 0.0 Log mar (9/10) -0.1 Log mar (12/10) +2.50 (-2.50)85 ° Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

OCT Visante

Corneal Flap OCT PRE OP : Size of corneal flap Post lasik ectasia on marginal pellucid corneal dystrophy Corneal Flap KERARING OCT POST OP KERARING: Depth: 310µm Corneal Flap: 120µm

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Orbscan Dual

Corneal Flap POST LASIK ECTASIA : Marginal pellucid corneal dystrophy OCT PRE OP POST LASIK ECTASIA Corneal Flap UCVA:0.5 Log mar BCVA:0.0 Log mar ° POST OP 1 Week KERARING UCVA :0.0 Log mar BCVA:-0.1 Log mar OCT POST OP POST LASIK ECTASIA POST KERARING DEPTH: 330µm Corneal Flap: 120µm

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

CONCLUSION

• Femtosecond intrastromal corneal ring segment implantation is an affective and safe method for the management of post lasik ectasia.

• Restores good level of visual acuity.

• Objective improvement of visual acuity.

– BCVA improved by 3 lines.

– Corneal astigmatism reduced by 2,6 d.

– Maximal keratometry reduced by 4.6 diopters.

– Reduce Hoa Rms.

• High patient satisfaction.

• Low complications rate.

• Reversible.

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Dominique Pietrini, MD, is a member of the active staff of the Clinique de la Vision, Paris France. Dr. Dominique Pietrini states that he is a paid consultant to Mediphacos.

Dr. Pietrini can be reached at +33 145 630 668 [email protected]

www.cliniquevsion .com

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Tony Guedj, OD,ORT Clinique de la vision, Paris France.

Tony Guedj can be reached at +33 145 630 668 [email protected]

Dominique PIETRINI / Tony GUEDJ (Paris)

INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA