world cornea congress vii – electronic poster season tse wing yeung, mbbs, franzco ronan conlon,...
TRANSCRIPT
Femtosecond Laser-Assisted Intrastromal Astigmatic Keratotomy for the Treatment of
Astigmatism Post-Penetrating Keratoplasty: 6- Month Outcomes of a Prospective Interventional
Case Series
World Cornea Congress VII – Electronic Poster
Season Tse Wing Yeung, MBBS, FRANZCO Ronan Conlon, MD; Joshua Teichman, MD, FRCSC; Setareh Ziai, MD, FRCSC;
George Mintsioulis MD, FRCSC; Kashif Baig, MD, MBA, FRCSC The University of Ottawa Eye Institute
Dr. Baig is a consultant for Alcon, Allergan, Bausch & Lomb, Labtician. Dr. Yeung, Dr. Conlon, Dr. Teichman, Dr. Ziai, Dr. Minsioulis have no financial interests in the subject matter of this presentation.
Introduction Visual rehabilitation post-penetrating keratoplasty (PKP) can be
difficult due the the high magnitude of astigmatism (up to 5D), which may not be correctable with glasses or contact lenses (38%)1
A number of corneal techniques have been described to address this problem including astigmatic keratotomy (AK)
The precision and accuracy of arcuate incisions in AK have significantly improved with the incorporation of femtosecond laser technology
Recent case reports have shown that femtosecond laser-assisted intrastromal astigmatic keratotomy (FISAK) is efficacious in the management of astigmatism in PKP patients2 1. Cleary, C et al. (2013) Cornea 32:54-622. Viswanathan, D (2013) JCRS 39:1916-20
Purpose
The purpose of this study is to report the outcomes of the correction of astigmatism with femtosecond laser-assisted intrastromal astigmatic keratotomy (FISAK) in patients with previous PKP
Methods
Prospective non-randomized interventional case series Inclusion criteria:
• Patients who had significant astigmatism following PKP• Complete suture removal at least 1 month prior to the procedure• Contact lens intolerance• Stable refraction
Paired intrastromal arcuate incisions were created with a femtosecond laser (IntraLase™; AMO)
Multiple postoperative visits were scheduled during the 6-month follow up period
Methods
• At each study visit, data as outlined were recorded: uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), slit lamp microscopy, IOP, manifest refraction, corneal topography, and anterior segment OCT
• The primary outcomes of the study were postoperative UCVA and BCVA
• The secondary outcomes were the reduction of refractive and topographic cylinder
• Intra-operative and postoperative complications were also documented
Results - DemographicsAge Eye UCVA BCVA Sphere (D) Cylinder (D) Topographic
Astigmatism (D)
1 24 OS 20/100 20/20 -3.50 4.50 6.2
2 71 OD 20/200 20/30 -11.25 8.00 4.9
3 69 OS 20/60 20/25 -3.00 5.25 4.5
4 40 OD 20/40 20/25 -5.75 5.00 5.1
5 33 OS 20/50 20/15 -5.75 6.00 5.8
6 75 OD 20/150 20/25 -6.50 7.00 7.1
7 69 OD 20/50 20/25 -1.00 5.00 4.3
8 87 OD 20/80 20/25 -6.00 4.00 3.5
9 87 OS 20/150 20/40 -8.25 5.00 5.6
10 55 OS 20/250 20/30 -12.25 8.00 12.0
Results
Ten patients were recruited (M:F = 6:4)
No serious adverse events were reported
At the 6-month follow up: Improvements in both mean UCVA and
mean BCVA were recorded A statistically significant decrease in mean refractive
sphere was observed: -5.67 + 3.00 D -4.33 + 3.44 D (P=0.01)
Results
For mean refractive cylinder: At the 1-month follow-up, mean
refractive cylinder reduced from: 5.52 + 1.27 D 3.55 + 1.90 D (P<0.001)
At the 6-month follow-up, the reduction in mean refractive cylinder continued: 5.52 + 1.27 D 2.67 + 1.61 D (P<0.001)
Results
1 2 3 4 5 6 7 8 9 100.001.002.003.004.005.006.007.008.009.00
Reductions in Mean Refractive Cylinders
PreopMonth 1Month 3Month 6
Diopters
Patients
Results
For mean topographic cylinder: At the 1-month follow-up, it decreased
from: 5.22 + 1.08 D 4.37 + 2.42 D (P<0.001)
At the 6-month follow-up, it continued to decrease: 5.22 + 1.08D 3.23 + 1.22 D (P<0.001)
There were no statistically significant changes in other topographic measurements
Results
1 2 3 4 5 6 7 8 9 100.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Reductions in Mean Topographic Cylinders
PreopMonth 1Month 3Month 6
Diopters
Patients
Conclusions
FISAK is a precise, effective, and safe technique in the treatment of high magnitude of corneal astigmatism in post PKP patients
A statistically significant reduction in mean refractive sphere was observed 6 months post FISAK
Significant improvements in both refractive and topographic cylinders were noted early postop, which continued to decrease at the 6-month follow-up
Intrastromal incisions provide a rapid postoperative recovery and an excellent safety profile