dominique pietrini, md tony guedj,od,orth clinique de la vision, paris. [email protected]

Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Dominique PIETRINI, MDTony GUEDJ,OD,ORTH

Clinique de la Vision, [email protected]

Financial disclosure: Dr D. Pietrini is a paid consultant for Mediphacos

Femtosecond laser assisted intrastromal corneal ring segment

implantation forpost-lasik corneal 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)


-3,46D

-4,81D

-2,04D -2D

0123456

spherical equivalent refractive cylinder

Spherical equivalent and refractive cylinder

Pre Op Post Op

N=13

Evolution of spherical equivalent and refractive cylinder


Evolution of uncorrected and best corrected visual acuity

N=13

UCVA

Mean gain 5 lines

BCVA

Mean gain 3 lines1,8

5,466,75

8,23

0123456789

UCVA BCVA

UCVA and BCVA

Pre Op Post Op p<0.05


Keratometric measurements Orbscan readings

N=13

Mean Kreduced by 3D

Kmaxreduced by 4.6D

45,84D52,21D

42,66D47,64D

0

10

20

30

40

50

60

Kmean Kmax Topo

Keratometry

Pre Op Post Op

Keratometry

p<0.05


Corneal astigmatism

N=13

-5,85D

-3,3D

01234567

Corneal astigmastism

Corneal astigmatism

Pre Op Post Op


High Order Aberration

2,822,55

-0,27

0,2

1,68

0,81

-0,22

0,16

1,4

0,86

-0,64

0,46

1,17

0,79

-0,49

0,39

-1

-0,5

0

0,5

1

1,5

2

2,5

3

HOA rms V.Coma

HOA Rms (µm)

Pre Op Post Op 1month Post Op 6months Post Op 2years

Z400

N=2

HOA Rms showed a reduction of 59% after 2years for Two eyesVertical Coma showed a reduction of 69% after 2years for Two Eyes

H.Coma


LEFT EYEPRE OP

1 Week afterKERARINGIMPLANTATION

KERATOMETRY: 38.4D /43.7D 3° 38.2D/40.9D 175°

ASTIGMATISM: 5.3D 2.7D

PACHYMETRY: 401µm 414µm

UCVA: 0.5 Log mar (3/10) 0.0 Log mar (9/10)

BCVA: 0.0 Log mar (10/10F) -0.1 Log mar (12/10)

REFRACTION: +1,75 (-4,50)85° +2.50 (-2.50)85°

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


OCT PRE OP : Size of corneal flap

Post lasik ectasia on marginal pellucid corneal dystrophy

OCT POST OP KERARING: Depth: 310µm

Corneal Flap: 120µm

Corneal Flap

Corneal Flap KERARING

OCT Visante


OCT PRE OP POST LASIK ECTASIA

OCT POST OP POST LASIK ECTASIA POST KERARING

DEPTH: 330µm Corneal Flap: 120µm

Corneal Flap

Corneal Flap KERARING

Orbscan Dual

PRE OPREFRACTION: +1,75 (-4,50)85° UCVA:0.5 Log mar BCVA:0.0 Log mar

POST OP 1 WeekREFRACTION: +2.50 (-2.50)85° UCVA :0.0 Log mar BCVA:-0.1 Log mar

POST LASIK ECTASIA : Marginal pellucid corneal dystrophy


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, MD, is a member ofthe active staff of the Clinique de la Vision,Paris France.

Dr. Dominique Pietrini states that he is a paid consultantto Mediphacos.

Dr. Pietrini can bereached at +33 145 630 [email protected] .com

mailto:[email protected]


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

Tony Guedj can bereached at +33 145 630 [email protected]

dominique pietrini, md tony guedj,od,orth clinique de la vision, paris. [email protected]

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