Transcript Visual and IOP Outcomes after PRK in Pigment Dispersion Syndrome

Visual and IOP Outcomes after PRK
in Pigment Dispersion Syndrome
[Poster Number: P190]
Kraig S. Bower, Denise A. Sediq, Charles D. Coe, Keith
Wroblewski, Chrystyna P. Kuzmowych, Jennifer Eaddy, Rose
Kristine C. Sia
Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC
The authors do not have any financial interests or relationships to disclose.
Disclaimer: 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.
Introduction: Pigment dispersion syndrome (PDS) is present in
approximately 4% of the population, and is more common in
patients with myopia. One study has reported the safety and
efficacy of LASIK in patients with PDS [Jabbur et al]. To date,
we have found no published study that evaluates the safety
and efficacy of PRK in patients with PDS.
Purpose: The purpose of this study is to analyze visual outcomes
and intraocular pressure following PRK in patients with PDS to
determine the safety and efficacy of PRK in patients with PDS.
Methods
• We retrospectively reviewed the records of refractive surgery
patients with clinical findings of PDS who underwent PRK at
the WRAMC Center for Refractive Surgery between January
2002 and July 2008.
• Records were reviewed for 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), cup-to-disc (C/D) ratio, and
postoperative complications, including steroid response
glaucoma.
Methods continued
• All data were analyzed using SPSS, version 15.0 (SPSS Inc.,
Chicago, IL). Repeated measures analysis of variance (RMANOVA) was used to examine IOP and corrected (Rosa,
Kolhaas, and Svedburg) measurements over time (significance
testing used an alpha=0.05). A Wilcoxon signed ranks test was
used to compare pre and post operative C/D ratio. Data are
presented as the mean ± standard deviation (SD), unless
otherwise indicated.
• In addition to analyzing the GAT measured postoperative IOP,
we also analyzed corrected IOP measurements. [Rosa et al.,
Kolhaas et al., Svedburg et al.].
Results
• 29 eyes of 15 soldiers (14 males and 1 female) mean age
37.7±7.0 years (range 24 to 49 years) with at least 12 months
follow-up were included for the review. Mean pre-operative
MSE was -3.69±2.22D (range -1.13 to -8.25D). Mean AD was
55.4±27.1μ (range 17.3 to 113.6μ). Mean CCT pre-operatively
was 567.6±23.9μ (range 513 to 608). Mean postoperative CCT
was 505.6±40.4μ (range 444 to 571).
• Patient data is presented in Table 1.
Table 1. Patient demographics and intraocular pressure (IOP) after PRK in
patients with pigment dispersion syndrome.
PATIENT
PATIENT 1
PATIENT 2
PATIENT 3
PATIENT 4
PATIENT 5
PATIENT 6
PATIENT 7
PATIENT 8
PATIENT 9
PATIENT 10
PATIENT 11
PATIENT 12
PATIENT 13
PATIENT 14
PATIENT 15
SEX
AGE
F/U (DAYS)
M
40
365
M
M
M
F
M
M
M
M
M
M
M
M
M
M
49
43
38
38
32
37
25
41
36
45
41
24
32
44
351
365
962
373
367
679
405
371
420
367
358
356
365
349
EYE
MSE*
AD**
PRE IOP
1 MO IOP
3 MO IOP
6 MO IOP
12 MO IOP
FINAL IOP
PRE C/D***
FINAL C/D STEROID RESONDER?
OD
-1.38
32.4
18
15
16
15
19
19
0.40
0.40
NO
OS
-1.50
27.7
17
16
16
18
19
19
0.40
0.40
NO
OD
-3.25
44.4
16
17
14
10
16
16
0.60
0.70
NO
OS
-3.88
58.8
14
13
10
14
12
12
0.55
0.65
NO
OD
-1.88
30.2
27
28
23
25
22
22
0.30
0.30
YES
OS
-2.63
39.6
23
24
18
21
22
22
0.30
0.30
YES
OD
-1.25
17.3
15
14
14
12
N/A
12
0.25
0.30
NO
OS
-----
-----
-----
-----
-----
-----
-----
-----
-----
-----
-----
OD
-7.63
113.6
18
17
10
18
12
12
0.30
0.25
NO
OS
-7.50
104.6
18
14
9
18
12
12
0.30
0.25
NO
OD
-4.50
66.3
18
13
12
11
15
15
0.20
0.20
NO
OS
-4.75
67.7
21
21
13
14
15
15
0.30
0.20
NO
OD
-1.25
26.7
17
10
N/A
12
N/A
12
0.35
0.40
NO
OS
-1.25
19.3
18
10
N/A
13
N/A
13
0.35
0.40
NO
OD
-3.25
52.6
16
14
12
10
8
8
0.20
0.35
NO
OS
-3.63
56.3
17
14
13
10
8
8
0.20
0.35
NO
OD
-3.63
52.7
13
14
20
13
15
15
0.35
0.25
NO
OS
-3.88
56.2
14
15
18
14
16
16
0.35
0.25
NO
OD
-3.13
52.6
24
32
13
15
19
19
0.40
0.40
YES
OS
-2.75
52.7
23
28
14
15
17
17
0.40
0.40
YES
OD
-1.13
30.6
16
17
16
16
19
19
0.30
0.30
NO
OS
-2.00
45.4
15
17
17
16
19
19
0.30
0.30
NO
OD
-3.88
56.2
14
15
12
15
16
16
0.30
0.30
NO
OS
-3.88
56.3
14
15
12
16
18
18
0.30
0.30
NO
OD
-1.88
30.6
21
15
18
19
19
19
0.20
0.20
NO
OS
-1.75
30.7
22
16
18
22
20
20
0.25
0.20
NO
OD
-7.50
94.5
10
11
17
12
11
11
0.30
0.30
NO
OS
-6.75
91.0
12
10
17
12
13
13
0.30
0.30
NO
OD
-8.25
101.1
16
10
14
16
11
11
0.30
0.20
NO
OS
-7.00
97.8
15
10
12
16
10
10
0.30
0.30
NO
Results
• Post-op 89.7% of eyes were within 0.5D and 100% within
1.00D of emmetropia. BSCVA was unchanged from pre-op in
82.8% of eyes, while 17.2% of eyes gained one line BSCVA. No
eye lost greater than one line BSCVA from any cause.
• Three of 15 patients (20%), including the patient with preexisting ocular hypertension, were steroid responders. All 3
were managed with addition of a single topical agent which
was discontinued after completing steroids.
• There was no significant change in mean C/D ratio from
baseline (0.322+/-0.091) to final visit (0.328+/-0.118, p=0.73).
UCVA follow-up with mean final FU 413 days post-op (range 349 to 962 days)
1 Month Post-Op (N=29)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
3 Month Post-Op (N=29)
96.6% 100.0%
100.0%
82.8%
69.0%
31.0%
0.0%
20/15
20/20
20/25
20/30
20/40
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
<20/40
89.7%
79.3%
48.3%
0.0%
20/15
20/20
UCVA (Cumulative)
93.1%
96.6%
96.6% 100.0%
69.0%
0.0%
20/15
20/20
20/25
20/30
20/40
UCVA (Cumulative)
20/25
20/30
20/40
<20/40
UCVA (Cumulative)
6 Month Post-Op (N=29)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
93.1%
<20/40
Final Post-Op (N=29)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
96.6% 100.0% 100.0% 100.0%
75.9%
0.0%
20/15
20/20
20/25
20/30
20/40
UCVA (Cumulative)
<20/40
IOP, Svedburg corrected IOP, Kolhaas corrected IOP, and Rosa corrected IOP over
time in postoperative PRK patients with PDS. (Error bars are standard error of the
mean). *Significantly different over time.
P=0.20
Conclusions
• Our refractive outcomes were similar to those reported by
other investigators and equivalent to our experience with
surface ablations in patients without PDS.
• While post-op steroid response was common, PRK is safe and
effective in patients with PDS if IOP is carefully monitored
postoperatively.
References
1. Jabbur NS, et. al. Outcomes of laser in situ keratomileusis in
patients with pigment dispersion syndrome. J Cataract
Refract Surg 2004;30(1):110.
2. Rosa N et al. Goldmann applanation tonometry after myopic
photorefractive keratectomy. Acta Ophthalmol Scand
1998;76(5):550.
3. Kolhaas M et al. A Correction Formula for the Real
Intraocular Pressure after LASIK for the Correction of Myopic
Astigmatism. J Refract Surg 2006;22:263-267.
4. Svedburg H et al. Changes in corneal thickness and curvature
after different excimer laser photorefractive procedures and
their impact on intraocular pressure measurements.