Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Purpose: To report the 6-month visual outcomes after wavefront-guided (WFG) photorefractive keratectomy (PRK) and laser in-situ
keratomileusis (LASIK) using the Alcon LADARVision excimer laser system. Methods: 62 subjects (42 PRK and 20 LASIK) were
included in this prospective, multi-center study. All subjects underwent WFG treatment in their dominant eye and conventional treatment
in their non-dominant eye. Outcome measures included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and
low contrast acuity (CA) at 6 months postop. High contrast (HC) BCVA, photopic 5% CA (80-140 cd/m 2), and mesopic 25% CA (0.8-1.2
cd/m 2) were performed with best correction and compared to preoperative measurements. Surgically induced changes were compared
for the four procedures: WFG PRK, conventional PRK, WFG LASIK, and conventional LASIK. Results: There was no difference in
UCVA or HC BCVA between treatment groups. The 5% CA improved by a mean of 0.02 logMAR following both WFG PRK and WFG
LASIK, compared to a mean decrease of 0.03 logMAR for both conventional procedures. The net difference in postop 5% CA between
WFG and conventional procedures was 0.05 logMAR (equivalent to half a line). The 25% CA decreased the most following conventional
LASIK (mean 0.04 logMAR) and conventional PRK (mean 0.03 logMAR). 25% CA following WFG LASIK decreased on average by only
0.01 logMAR, and improved by 0.02 logMAR following WFG PRK. Conclusions: Although HC visual acuity was equal following all 4
procedures, low contrast acuity was generally better following PRK than LASIK, and better with WFG treated compared to conventional
treatments. There was an overall improvement in 5% CA for eyes treated with WFG procedures compared to a slight decrease in
performance for those eyes treated with conventional procedures. Of the four procedures, only the WFG PRK improved mesopic
25% CA postoperatively. WFG PRK appears to provide excellent quality vision, particular in low contrast low light environment.
4336 - B694
CR: R. VanRoekel, None; S.C. Schallhorn, None; K. Lombardo, None; J.M. Burka, None; K.S. Bower, None; R.D. Stutzman,
None; C.P. Kuzmowych, None. Support: None.
4337 - B695
4338 - B696
Axial Length and IOP Changes With Application of the IntraLase and Moria M2
Suction Rings
W.W. Culbertson1, F.Marangon1, S.H. Yoo1, C.A. Acosta1,2, I.Nose1, P.Superne1, J.Parel1,3.
1
Ophthalmology, Bascom Palmer Eye Institute, Miami, FL; 2Hospital Oftalmolgico Dr.
P.Lagleyze, Buenos Aires, Argentina; 3CHU Sart-Tilman, Univ. of Liege, Liege, Belgium.
Purpose: To determine how the axial length and the intraocular pressure changes when the
IntraLase suction ring interface and the Moria M2 suction ring are placed on the human eye.
Methods: Ten fresh human cadaver eyes (ve pairs) and six eyes (three pairs) of living
volunteers were studied. Intraocular pressures and axial lengths were obtained both
prior to and during application of an IntraLase suction ring to one of a pair of the eyes.
Similar measurements were obtained with application of a Moria M2 suction ring.
Results: Intraocular pressures increased with both suction rings to between 71 to 84 mmHg
during application of suction in both living and cadaver eyes. Axial lengths either remained
unchanged or shortened during suction application in both IntraLase and Moria M2 cadaver or
living human eyes. The average decrease in axial lengths was 0.47mm for IntraLase cadaver
eyes and 82mm for Moria cadaver eyes. In three pairs of living volunteer eyes the axial length
shortened on the average of 0.19mm for IntraLase eyes and 0.12mm for Moria M2 eyes.
Conclusions: The intraocular pressure is raised signicantly when either the IntraLase or the
Moria M2 suction ring is applied to the human eye. Contrary to recent reports of elongation
of axial length with the Moria M2 suction ring (Flaxel et al, Ophth 111:24-27;2004), we
found that the axial length decreases (instead of increases) when either type of suction ring
is applied to living or cadaver human eyes.
CR: W.W. Culbertson, Intralase R; F. Marangon, None; S.H. Yoo, Intralase R; C.A.
Acosta, None; I. Nose, None; P. Superne, None; J. Parel, None.
Support: NIH center grant P30-EY014801; Research to Prevent Blindness; Henri and Flore
Lesieur Foundation
4339 - B697
4340 - B698
Safety and Efcacy of the Moria Epi-K for Epi-LASIK in Four Centers Worldwide
B.Soloway1, M.Swanson2, R.Rashid3, J.Bai4, C.Starr1, D.Jardim1. 1Vision Correction, New
York Eye and Ear Inrmary, New York, NY; 2Ophthalmology, Swann Ophthalmology and
Laser Institute, Aqua Prieta, Mexico; 3Vision Correction, Eye Physicians and Surgeons,
Charleston, WV; 4Ophthalmology, Chongqing Daping Hospital Eye Center, Chongqing,
China.
Purpose:To assess the safety and eff icacy of the Moria Epi-K for Epi-LASIK
in the hands of 4 refractive surgeons in the United States, Mexico and China.
Methods: Four surgeons performed Epi-LASIK with the Epi-K on 93 eyes. One Single
Use head and one Single Use Plus ring were used per patient. Preoperatively, the spherical
equivalent range was -9.75 D to +3.75. Keratometry ranged from 40.1 to 49.75 D. Pachymetry
ranged from 468 to 634 microns. Flap thickness was measured with ultrasound by subtraction
pachymetry. Flap dimensions were measured with manual or laser calipers. Epithelial ap
quality was evaluated subjectively. Additionally, ap complications, postoperative BSCVA,
patient reported pain level, ability to return to work and time of contact lens removal were
reported. All centers were subject to IRB monitoring and adherence to the Helsinki agreement
Results: An epithelial ap was successfully created in all eyes. We (BS) achieved an average
thickness of 52 +/- 9.6 (38-79) microns in 16 eyes. MS, JB, and RR respectively obtained an average
ap thickness of 46 +/- 8.3 (26-65) microns in 32 eyes, 54 +/- 10 (33-73) microns in 27 eyes and
50 +/- 11 (33-71) microns in 18 eyes. The average ap diameter was 9.2 +/- 0.2 (9-9.5) mm. MS,
JB, and RR respectively obtained an average ap diameter of 9.2, 9.5 and 9.0 mm. Intra-operative
complications were limited to an isolated area of retained epithelium on ap generation in 1 eye and
3 epithelial defects created during ap repositioning with a metal cannula. Postoperatively, 2 eyes
had spontaneous loss of their bandage contact lens (BCL). The BCL was removed between day 3
and day 5 postoperatively. A minimum of 51% of patients were able to return to work on post-op day
three and 87% by post-op day 4 at any center. No patient reported signicant pain by the third post-op
day. No eyes lost BSCVA in any center and up to 42% gained one or more lines at the six-month visit.
Conclusions: The Epi-LASIK with the Moria Epi-K is a safe procedure. The Epi-K creates predictable
and uniform epithelial aps. Flap management techniques and bandage contact lens selection should
be adapted to Epi-LASIK.
CR: B. Soloway, Moria R; M. Swanson, Moria R; R. Rashid, Moria R; J. Bai, None; C. Starr,
None; D. Jardim, None.
Support: None.
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43354340
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4341 - B699
4342 - B700
4343 - B701
4344 - B702
Purpose: To prospectively compare four excimer laser systems for the treatment of
high myopia with LASIK using a night driving simulator to track visual performance.
Methods: Detection and identication distances of 2 different road signs and a pedestrian
hazard during nighttime driving (rural road at 55 mph, Vision Research Sciences Corp.) with
and without glare was measured in 75 subjects before and 6 months after conventional LASIK
(4 different lasers; preop MSE -5.712D). Each eye was tested independently. 21subjects/42 eyes
were treated with the Alcon Ladarvision 4000, 18/36 with a Bausch & Lomb Technolas 217, 18/36
with a Nidek EC-5000, and, 18/36 with a VISX laser system. Laser group treatments (sphere,
cylinder, MSE) were similar (ANOVA, p0.7). A fth group (28 /56 eyes) of higher myopia
patients treated with the VISX laser (mean MSE=-7.92D) were prospectively measured, as well.
Results: Signicant differences between the four lasers in night driving performance was observed
(MANOVA, p<<0.001); postop to preop performance was not changed for the VISX, slightly reduced
for Alcon, reduced for B&L, and even more reduced in the Nidek group (ANOVA, =0.05). In the
Nidek cohort, average reduction in performance ranged from -29.5ft (0.37sec; 95%CI=-19.3 to
-39.7ft) to -40.7ft (0.50sec; 95%CI= -25.0 to -56.6ft) for detection without glare to identication
with glare, respectively. Change in performance was not signicantly determined by type of road
hazard (trafc or business sign, or pedestrian) or which eye (right/left or dominant/non-dominant)
was used (MANOVA, p0.13). Contrast sensitivity (photopic 5% contrast acuity), intensity of
treatment (extent of myopia), and subjective night glare/halo complaint (index of multiple
questions) all correlated with the change in visual performance during simulated night driving.
Conclusions: Night driving visual performance can be degraded after conventional myopic LASIK
and more frequently with certain laser systems. Changes in the quality of vision, measured clinically
and assessed subjectively, correlated with night driving visual performance.
CR: S.E. Kaupp, None; S.C. Schallhorn, None; D.J. Tanzer, None; C. van de Pol, None; S.E.
Malady, None; K.M. Lombardo, None; M. Brown, None; L. Bourque, None.
Support: None.
4345 - B703
4346 - B704
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43414346
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4347 - B705
4348 - B706
4349 - B707
4350 - B708
Diffuse Lamellar Keratitis: Risk Factors and the Effect on Visual Acuity Following
LASIK
E.-S.Han1,2, W.-R.Wee2,3, J.-H.Lee1,2, M.-K.Kim1,2. 1Ophthalmology, Seoul Natl Univ Hosp,
Seoul, Republic of Korea; 2Articial Eye Center, Seoul National University Hospital
Clinical Research Institute, Seoul, Republic of Korea; 3Ophthalmology, Seoul Natl Univ
Bundang Hosp, Seongnam city, Gyoung-gi, Republic of Korea.
Purpose: To investigate the risk factors of diff use lamellar keratitis
(DLK) and to evaluate the effect of DLK on visual acuity after LASIK.
Methods: 144 eyes of 75 patients who underwent LASIK with Visx S4(VISX Inc., Santa Clara,
CA) and M2(Moria, Antony, France) and who were followed at least six month were included.
The effect of various factors -age, sex, previous dry eye, the history of contact lens wearing,
intraoperative ap-lifted time, intraoperative bleeding, postoperative immediate steroid
instillation- was evaluated in DLK and non-DLK group. Postoperative log MAR visual acuities
and log contrast sensitivity(CS) using the VCTS6500(Vistech Consultants, Inc., Dayton, OH)
were compared with those of pre-operation in DLK and non-DLK group at 3, 6 months after LASIK.
Results: Only intraoperative bleeding was signicantly related to the development of
DLK(p=0.001). There was no difference of log MAR visual acuities between in DLK and non-DLK
group till 6 months. However, the CS signicantly decreased in 3, 6, 12 cycle/degree compared with
that of pre-operation((p=0.025, p=0.011, p=0.027) in DLK group, whereas the CS signicantly
increased in 6 and 12 cycle/degree in non-DLK group (p=0.032, p=0.016) at six months.
Conclusions: DLK seemed to be strongly associated with intraoperative bleeding and
postoperative decrease of contrast sensitivity.
CR: E. Han, None; W. Wee, None; J. Lee, None; M. Kim, None.
Support: None.
4351 - B709
4352 - B710
Purpose:
To
determine
the
s a f e t y,
eff icacy
and
stability
of
i n t r a s t r o m a l c o r n e a l r i n g s ( IC R s) 10 ye a r s a f t e r pl a c e m e n t fo r myo p i a .
Methods:Ten eyes with myopia treated with the placement of ICRs (360 degree PMMA ring placed in the
peripheral cornea) were evaluated at 10-year follow-up for the following: 1) uncorrected visual acuity (UCVA),
2) best spectacle-corrected visual acuity (BSCVA), 3) manifest refraction spherical equivalent (MRSE), 4)
induced manifest refraction cylinder (IMRC), and 5) self-reported symptoms. In addition, all patients had
wavefront analysis, topography, pachymetry, slit lamp examination, keratometry and Schirmer testing. Ten year
data were compared to 1-year postoperative results to assess visual stability and safety of implants over time.
Results: Data showed that UCVA was 20/30 or better in 80% of eyes and 20/60 or better in 90% of eyes at
1-year follow-up, which is similar to the 60% and 90%, respectively, 10 years after ring placement. One-year
follow-up MRSE ranged from -3.37 diopters to -.12 diopters with a mean of -1.33 diopters. Ten-year MRSE
ranged from -2.87 diopters to +1.50 diopters with a mean of -0.85 diopters. This indicated no statistically
signicant difference in MRSE (F(1,8)=1.57, p=ns) indicating stability from 1-year to 10-year follow-up.
Induced manifest cylinder at 10 years ranged from reduction of as much as .75 diopters of astigmatism to
induction of 1.00 diopter of astigmatism in one case with 70% of patients experiencing induction of 0.25 diopters
of cylinder or less. Mean central pachymetry at 1-year was 540 microns and at 10-year was 565 microns. This
was not a statistically signicant difference (F(1,7)=2.70, p=ns). While patients remained largely satised at
10 years, 50% reported mild blurring of vision and 60% reported mild difculty with night vision. Slit lamp
examinations showed stable ring position and clear corneas in all eyes without signicant structural change.
Conclusions: Intrastromal corneal rings are a safe, effective and stable method of correcting mild to moderate
myopia and most patients continue to be satised with the results after ten years. Refraction and corneal
examinations show stability of effect 10 years after ICR placement and there was no evidence of any safety
issues or corneal instability 10 years post operatively. ICR and Intacts offer a non-laser and reversible
alternative for correcting mild to moderate myopia without removal of tissue and without manipulation of
the central cornea.
CR: A.P. Schwartz, None; F. Esmail, None; H.N. Naikoo, None; A. Babayan, None; B. Tinio, None; P.
A. Asbell, None.
Support: NEI core grant to the Dept. of Ophthalmology at Mount Sinai Hospital, RPB2 (Dr. Penny A.
Asbell)
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43474352
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4353 - B711
4355 - B713
4354 - B712
4356 - B714
Long-Term Keratocyte Decits in the Corneal Stroma After LASIK and PRK
J.C. Erie, C.B. Nau, J.W. McLaren, D.O. Hodge, W.M. Bourne. Ophthalmology, Mayo
Clinic, Rochester, MN.
Purpose: To determine changes in keratocyte density up to 5 years after LASIK and PRK.
Methods: 17 eyes of 11 patients received LASIK with a planned 180-m ap to correct
refractive errors between -2D and -11D. 18 eyes of 12 patients received PRK to correct
refractive errors between -1.5D and -5.75D. Corneas were examined by using confocal
microscopy before and at 1, 2, 3, and 5 years after the procedures. In PRK patients, cell densities
were determined in 5 stromal layers; 0% to 10% (anterior), 11% to 33%, 34% to 66%, 67% to
90%, and 91% to 100 % (posterior). In LASIK patients, cell densities were determined in the
stromal ap, the anterior and posterior halves of the 100-m-thick retroablation layer, and
the posterior third of the stroma (the region of the stroma that was ablated was omitted from
analysis). Differences between pre- and post-operative cell densities were determined by
using generalized estimating equation models with Bonferroni correction for 4 comparisons.
Results: Before PRK, mean keratocyte density in the anterior 10% of the stroma was
32,084 5,870 cells/mm 3 ( SD). Cell density in this region decreased after PRK by 39%,
42%, 45%, and 47% at 1, 2, 3, and 5 years respectively (P<0.001). At 5 years after PRK,
cell density was decreased by 20-24% in the posterior two thirds of the stroma (P<0.03).
Before LASIK, mean keratocyte density in the stromal ap was 30,104 4,576 cells/
mm 3. Cell density in the stromal ap decreased after LASIK by 23% (P<0.002) at 1 year
and 37% (P<0.001) at 5 years. Cell density in the anterior retroablation layer decreased
after LASIK by 18% (P<0.001) at 1 year and 43% (P<0.001) at 5 years. At 5 years after
LASIK, cell density was decreased by 19-22% (P<0.02) in the posterior third of the stroma.
Conclusions: Keratocyte densities are decreased for up to 5 years in the anterior stroma
after PRK and in the stromal ap and in the anterior retroablation layer after LASIK. A
decrease in posterior stromal keratocyte density is rst noted at 5 years after LASIK and
PRK. We also consider several artifacts of confocal microscopy that might explain some of
these differences.
CR: J.C. Erie, None; C.B. Nau, None; J.W. McLaren, None; D.O. Hodge, None; W.M.
Bourne, None.
Support: NIH Grant EY02037 and Research to Prevent Blindness, Inc., Mayo Foundation,
Rochester, MN
4357 - B715
4358 - B716
Purpose:
To
measure
pupil
center
decentration
over
time
after
the
instillation
of
myd r iat ic
and
miotic
phar maceutical
agents.
Methods: Thirty preoperative eyes (15 subjects) were enrolled in this prospective non-randomized
study. All measurements were made using the Zywave II WaveFront Aberrometer (v.4.45sp3).
Phase I (Dilation): Pupil center location and wavefront measurements were captured at baseline and in 5
minute intervals up to 30 minutes after instillation of 1 drop each of 2.5% phenylephrine and 1% tropicamide.
Phase II (Dilation Reversal): Two drops of 0.5% dapiprazole hydrochloride (REV-EYES; Bausch &
Lomb, NY) were instilled 30 minutes after completion of Phase I. An additional 2 drops were added 5
minutes later according to package insert dosage recommendations. Pupil center location and wavefront
measurements were captured in 30 minute intervals from 90 to 180 minutes after instillation of REV-EYES.
Results: Phase I: Mean pupil center decentration was statistically and clinically signicant within the
rst 15 minutes after instillation of the mydriatic combination (ANOVA, p<0.001) in the vertical
meridian. After the 15 minute time point, pupil center decentration in the vertical meridian stabilized
at a magnitude of -150um. There was no statistically signicant mean pupil center decentration in the
horizontal meridian (ANOVA, p=0.169) in the dilation phase. A mean spherical refractive error
shift of +0.45D (p=0.024) and mean Defocus (Z200) shift of -0.35um (p<0.027) were observed by 20
minutes after dilation. There were no statistically signicant changes in mean higher order aberrations
normalized to baseline (p>0.05), although signicant variation in individual eyes were observed.
Phase II: Mean pupil center decentration in the vertical meridian stabilized at a magnitude of about +125um
(p<0.001), 3 hours after instillation of REV-EYES. There were no statistically signicant changes in mean higher
order aberrations normalized to baseline (p>0.05), although signicant variation in individual eyes were observed.
Conclusions: Signicant variability of pupil center decentration was observed early in the dilation time
course, as a result of asymmetric pupil mydriasis. The results suggest that wavefront measurements should
be made at least 20 minutes after instillation of mydriatic agents, when the pupil center location is stabilized.
Mydriatic reversal drops should not be used with the intent of performing same-day refractive surgery, as
centration of the treatment will not coincide with the manifest pupil center location.
CR: M.M. Merchea, Bausch & Lomb E; M. Lagana, Bausch & Lomb E; I. Cox, Bausch & Lomb E.
Support: None.
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43534358
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4359 - B717
4360 - B718
4361 - B719
4362 - B720
Preservation of Contrast Sensitivity After LASIK and Clear Lens Extraction With
PCIOL Placement in the Treatment of Mild to Moderate Hyperopia
E.K. Chiu, M.P. Rubin, S.Rao. Ophthalmology, University of Chicago, Chicago, IL.
Purpose: To compare the efcacy of LASIK and clear lens extraction with PCIOL
placement (CLE) for the treatment of mild to moderate hyperopia (+1 to +6 D) in
patients over 40 years of age. In particular, we evaluated the impact of these procedures
on the preservation of contrast sensitivity as well as post-operative visual acuity.
Methods: A retrospective review was performed on consecutive patients who underwent
refractive correction for low to moderate hyperopia. Hyperopic LASIK was performed on 50 eyes
of 26 patients. Phacoemulsication and IOL implantation was performed on 50 eyes of 25 patients.
Results: In the LASIK group, postoperative UCVA was 20/40 or better in all eyes, with a
median UCVA of 20/25 (range 20/20 to 20/40.) Postoperative spherical equivalent was 0.12D
(-0.75 to + 0.75) reduced from preoperative level of 2.75D. In the CLE group, postoperative
uncorrected visual acuity (UCVA) was 20/40 or better in all eyes, with a median UCVA
of 20/25 (range 20/20 to 20/40.) Postoperative spherical equivalent was 0.155D (-0.75 to
+0.75) reduced from preoperative level of 3.59D. Contrast sensitivity curves decreased by
two or more lines in two hyperopic CLE eyes (4%) and 7 hyperopic LASIK eyes (14%.)
Conclusions: In low to moderate hyperopia, clear lens extraction with IOL implantation
preserved contrast sensitivity at a higher rate than LASIK. Additionally, CLE is a safe
procedure and yields comparable postoperative UCVA to LASIK.
CR: E.K. Chiu, None; M.P. Rubin, None; S. Rao, None.
Support: None.
4363 - B721
Thick versus Thin Laser in situ Keratomileusis Flaps in the Correction of Myopic
Astigmatism
E.A. Steele, F.W. Fraunfelder. Ophthalmology, Casey Eye Institute, Portland, OR.
P u r p o s e : To e v a l u a t e r e t r o s p e c t i ve l y t h e e f f e c t s of L A S I K
f lap
thick ness
in
the
cor rection
of
myopic
astig matism.
Methods: Patients with low to moderate myopia with astigmatism up to -3.75
diopters were included in the study. The eyes were divided into two groups based
on ap thickness, with 171 eyes having ap thickness less than 126 microns and
171 eyes having ap thickness greater than or equal to 126 microns. Six-month data
were analyzed with regard to spherical power, spherical equivalent, astigmatism
power, astigmatism axis, uncorrected visual acuity, and vector astigmatism change.
Results: Mean change in total spherical correction 6 months after surgery for eyes with
LASIK ap thickness less than 126 microns was -3.79 1.90. For ap thickness greater
than or equal to 126 microns, the difference was -2.94 1.99 ( p=0.0001). Mean change
in spherical equivalent 6 months after surgery for eyes with LASIK aps less than 126
microns was 4.11 1.90 diopters compared to 3.19 2.01 for aps greater than or equal to
126 microns (p=0.00003). Mean change in astigmatism magnitude 6 months after surgery
for eyes with LASIK aps less than 126 microns was 0.65 0.80 diopters compared to 0.50
0.71 for aps greater than or equal to 126 microns (p=0.08). Mean change in astigmatism
axis 6 months after surgery for eyes with LASIK aps less than 126 microns was 33.02
82.4 degrees compared to 17.51 81.5 degrees for aps greater than or equal to 126 microns
(p=0.07). Mean change in uncorrected visual acuity (LogMAR) for LASIK aps less than 126
microns was 1.36 0.42 compared to 1.10 0.55 for aps greater than or equal to 126 microns
(p=0.000002). Mean vector-corrected astigmatism change was 1.04 0.75 diopters for LASIK
aps less than 126 microns compared to 0.94 0.67 diopters for aps greater than or equal
to 126 microns (p=0.2). The mean change in axis for vector-corrected surgically-induced
astigmatism at 6 months after surgery was 1.17 52.6 degrees for aps less than 126 microns
compared to 1.94 51.4 degrees for aps greater than or equal to 126 microns ( p=0.89).
Conclusions: There was no signicant difference in myopic astigmatism correction based
on the thickness of the LASIK ap at 6 months after surgery.
CR: E.A. Steele, None; F.W. Fraunfelder, None.
Support: None.
LASEK Induces Less Corneal Wound Healing and Better Transmittance Than PRK in
the Iber Braun Hens Corneal Model
J.M. Merayo-Lloves1A, H.A. Martinez-Osorio1A, T.Blanco-Mezquita1A, C.MartinezGarcia1B, S.Mar-Sardaa1C, R.M. Torres1A. AOphthalmology IOBA, BCell Biology, CPhysics
Applied, 1Universidad de Valladolid, Valladolid, Spain.
P u r p o s e : To c omp a r e c or ne a l wou nd he a l i ng a nd t r a n s m it t a nc e
af ter laser subepithelial keratomileusis (LASEK) and photoref ract ive
k e r a t e c t o m y ( PR K ) i n t h e I b e r B r a u n h e n s c o r n e a l m o d e l .
Methods: LASEK surgery (-6 D, optical zone 6.0 mm, 67 m) was performed on Iber
Braun hens (2,5 kg) corneal model. Iber Braun hens corneal epithelium was exposed to 20%
ethanol in BBS for 40 seconds using as the reservoir a 7.5 mm trephine. The epithelium was
detached by the technique in the bag and then treated with an excimer laser (Summit apex
plus). The epithelial ap was repositioned. Morphologic changes were evaluated by optic
(H-E) and electronic microscopy examination. Proliferation and apoptosis were studied at
24 and 72 hours. The transmittance and scattering measurements were done with a scatter
meter constructed in the Optics Department (University of Valladolid) at 15 and 30 days.
Results: LASEK corneas showed TUNEL positive cells in the basal layer of the
epithelial ap. In the stroma, there are less keratocyte apoptosis in LASEK than PRK
corneas at 24 hours, and both of them decreased at 72 hours but remained higher after
PRK than LASEK. Keratocyte proliferation rate at 72 hours were higher in the two
superior thirds of the corneas in the PRK than the LASEK model. LASEK corneas
had less scattering and better transmittance than PRK corneas at 15 and 30 days.
Conclusions: LASEK induces less stromal scarring compared to PRK in the Iber Braun hens
corneal model. LASEK corneas have better transmittance than PRK corneas. Iber Braun hens
offer a very good model of LASEK corneal refractive surgery.
CR: J.M. Merayo-Lloves, None; H.A. Martinez-Osorio, None; T. Blanco-Mezquita,
None; C. Martinez-Garcia, None; S. Mar-Sardaa, None; R.M. Torres, None.
Support: H. Martinez-Osorio, Carolina Foundation, Ministry of foreign affairs, Spain
Purpose: To analyze the role of spherical aberrations (HOA) on customized LASIK refractive outcome.
Methods: Data from 330 myopic eyes, treated with customized ablation, with Technolas
217z, was followed through six months post-LASIK. Data was classied according to the
amount of preoperative myopia, spherical aberration (SA), and change in astigmatism. The
manifest and wavefront predicted phoropter refractions (PPR) were represented using power
vectors: MSE (mean spherical equivalent), J0 (astigmatism at 0 or 90), and J45 (oblique
astigmatism). The role of SA on post-LASIK manifest refraction was analyzed using ANOVA.
Results: 1) Increased SA was associated with increased sphere treatment magnitude (r=0.65, p<0.0001).
Greater post-LASIK positive SA was signicantly correlated to post-LASIK hyperopia (r=0.45, p<0.0001).
2) Change in SA (post - pre LASIK), or SA, was lower among eyes with high preoperative
SA and greater among those with lower preoperative SA (r=-0.35, p<0.0001). Eyes
with negative preoperative SA had greater SA than those with positive spherical
aberration (t>3.26, p<0.0001). Among eyes with high preoperative positive SA (>0.35
um), SA was inversely correlated to the postoperative hyperopia (r= 0.32, p= 0.028).
3) SA was significantly correlated to MSE (r>0.62, p<0.0001) and J0 (r>0.51,
p<0.001) among eyes with post-LASIK hyperopia and low astigmatism (r= -0.35,
p<0.0001). 3rd RMS and SA were signicantly correlated to MSE (r>0.53, p<0.001)
and J45 (r>0.42, p= 0.003) among eyes with high post-LASIK astigmatism (>0.75 D).
Conclusions: Post-LASIK SA was signicantly correlated to post-LASIK hyperopia. Eyes with
greater preoperative positive SA, have a greater reduction in SA but also tend to be more hyperopic.
Eyes with greater negative SA tend to become more emmetropic or myopic. Increased 3rd RMS was
associated with post-LASIK residual astigmatism. The role of HOA, especially SA, on post-LASIK
refractive outcome is discussed from a biomechanical perspective.
CR: M.V. Subbaram, None; S.M. MacRae, Bausch and Lomb F, C; G. Yoon, Bausch and Lomb
F, C; I.G. Cox, Bausch and Lomb E.
Support: Bausch and Lomb
4364 - B722
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43594364
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4365 - B723
4367 - B725
4366 - B724
Purpose: Night vision difficulties consisting of starbursts, glare, and halos are common
complaints following refractive surgery. Previously, we have shown starbursts to be detectable
in over 90% of post-LASIK patients with the Larson Glarometer (Snyder, presented at annual
meeting ARVO 2002). Wavefront guided LASIK is thought to reduce night vision symptoms
of starbursts, glare, and halos. In this study, we objectively measure and compare starbursts
experienced in patients after conventional LASIK with those after wavefront-guided LASIK.
Methods: Three groups of patients were independently studied. The rst group consisted of postconventional LASIK patients. The second group consisted of post-wavefront-guided LASIK patients.
The third was a non-surgical control group that consisted of myopic spectacle wearers with corrected
visual acuity of better than 20/25. All eyes included in this study required no more than 6 diopters
of myopic correction. All post-surgical eyes had uncorrected visual acuities of 20/25 or better. Both
LASIK procedures were performed with standard techniques and nomograms on the VISX S4 using a
6.5 mm optical zone and an 8 mm blend zone. Starburst radius (SR) was recorded in uncorrected eyes
a minimum of 3 months following refractive surgery. A Larson Glarometer was used to quantify the
SR. This device, consisting of two low intensity red light sources separated by 4 inches, was placed
8 feet from the subject in a totally dark room. After 15 seconds of dark adaptation, the subjects were
asked to compare their perceived starburst pattern to a key card depicting starbursts of different
radii. The minimum measurement on the starburst key was 4.0 mm., and the maximum was 50 mm.
Results: A total of 72 eyes were measured. In the conventional LASIK group (n=23) the average starburst
radius (SR) was 20.4 mm. In the wavefront guided LASIK group (n=26), the average SR was 11.75 mm. In
the spectacle control group (n=23) the average SR was (5.5 mm). Both surgical groups showed a statistically
signicant increase in SR when compared with the control group (p<0.01). The wavefront-guided LASIK
group showed a statistically signicant decrease in SR compared with conventional LASIK (p<0.05).
Conclusions: Using an innovative new device for measuring starburst patterns, our data was able to
conrm a statistically signicant increase in the amount of starburst pattern glare experienced after
both conventional and wavefront-guided LASIK compared with spectacle wearers. In addition, this
study demonstrates a new nding: a statistically signicant decrease in starburst pattern glare with
wavefront-guided LASIK compared with conventional LASIK.
CR: M. Shah, None; B. Larson, None.
Support: None.
4368 - B726
4369 - B727
4370 - B728
Initial Clinical Experience in Epi-LASIK With the Moria Epi-K Epithelial Dissector
and the Allegretto Wave Eye-Q Excimer in 25 Myopic Eyes
A.Kanellopoulos. Ophthalmology, Laservision.gr Institute, Athens, Greece.
Purpose: To evaluate the safety and efcacy of the Epi-K epithelial dissector by Moria used
with the ALLEGRETTO Eye-Q excimer laser system in epi-LASIK for myopia and myopic
astigmatism.Methods: Twenty ve consecutive LASIK cases for Myopia with or without
astigmatism treated with epi-LASIK were prospectively evaluated up to 12 months post
operatively. The mean pre-operative sphere was -3.08 (SD+/- 1.56) D with a range of -0.25
to -6.00 D. The mean preoperative cylinder was -0.80 (SD+/- 1.01 D) (range 0 to -4.00). ).
Epithelial Flaps were created with the Moria epi-K (Moria SE, Antony, France) microkeratome.
Parameters evaluated were pre and post-operative refractive error, UCVA, BSCVA, time to
epithelial healing, post-operative discomfort, higher order aberration change and contrast
sensitivity. Results: All twenty ve eyes were available for follow up at 12 months. Mean
uncorrected visual acuity improved from preoperative of 20/200 (SD+/-0.23) to 20/23 (SD+/0.173) 89% of eyes were within +/- 0.50 D of refractive goal respectively. None of the eyes
lost more than 2 lines of BSCVA. Epithelium stabilized in average at day 5 (+/- 1). Discomfort
was graded +2.5 on a 1-5 scale There was an average increase in higher order aberrations
(RMSH) by 36%. Conclusions: Epi-LASIK with the epi-K microkeratome apperas to be a
safe and effective refractive surgery alternative for moderate myopes.
CR: A. Kanellopoulos, None.
Support: None.
Purpose: To describe the rst reported case of chorioretinal folds after laser in situ Keratomileusus (LASIK)
M e t h o d s : A 47 y e a r o l d m a l e d e v e l o p e d b i l a t e r a l c h o r i o r e t i n a l
folds
following
uncomplicated
LASIK
for
hyperopia.
Results: After a complete examination by the retina service, he was diagnosed with bilateral
idiopathic/hyperopic chorioretinal folds. He has been followed for ten months and has persistent
choroidal folds but his best corrected visual acuity remains stable; OD 20/25 and OS 20/20
Conclusions: Chorioretinal folds have been associated with numerous conditions including: orbital
tumors, posterior scleritis, and hyperopia, etc. They have also been reported following surgical
procedures such as trabeculectomy and pars plana vitrectomy. To our knowledge this is the rst
reported case of chorioretinal folds diagnosed in the post-operative period following LASIK.
A 47 year-old male underwent bilateral simultaneious hyperopic LASIK using a Hansatome and
Technolas 217 laser. A complete preoperative dilated ophthalmic exam demonstrated normal retinas
and stable hyperopic refraction. The patient did have poor BCVA due to anterior basement membrane
dystrophy which improved following bilateral diamond burr supercial keratectomy prior to LASIK.
Following LASIK, UCVA was 20/20 OU on day #1. However, six months post-LASIK his UCVA
OD gradually dropped to 20/100 and OS to 20/40 due to hyperopic regression. Dilated fundus
examination did not demonstrate any abnormalities. An uncomplicated enhancement was performed
on the right eye 30 weeks after the initial procedure by ap lift. After one month, dilated fundus
exam, uorescenin angiography.and optical coherence tomography demonstrated choroidal folds
OU. Axial lengths were found to be OD 21.58mm and OS 22.04mm. Consultation with a retinal
specialist was sought who felt the choroidal folds were most consistent with idiopathic/hyperopic folds.
Given the possibility that the LASIK procedure may have produced or exacerbated the choroidal
folds and the greater likelihood for folds to occur in short eyes, the authors recommend obtaining
pre-operative axial length measurements and preforming a careful dilated fundus exam in patients
undergoing hyperopic refractive procedures. A discussion should be had with the patient about the
possibility of choroidal folds occurring post-operatively in eyes with short axial lengths. Choroidal
folds should also be considered in the differential diagnosis of hyperopic regression following
refractive surgery. Dilated retinal examination should be performed prior to any enhancement in a
patient with hyperopic regression.
CR: M.G. Parker, None; Q. Farjo, None. Support: None.
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43654370
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4371 - B729
4372 - B730
Recovery of Corneal Subbasal Nerve Density Is Slower After LASIK Than After
PRK
E.J. Winter1A, J.C. Erie1A, C.B. Nau1A, J.W. McLaren1A, D.O. Hodge1B, W.M. Bourne1A.
A
Ophthalmology, BBiostatistics, 1Mayo Clinic College of Medicine, Rochester, MN.
Purpose: To measure corneal reinnervation during 5 years after LASIK and PRK.
Methods: 16 eyes of 11 patients received LASIK with a planned 180-m ap to correct
refractive errors between -2D and -11D. 18 eyes of 12 patients received PRK to correct refractive
errors between -1.5D and -5.75D. Corneas were examined by using confocal microscopy before
and at 1, 2, 3, and 5 years after the procedures. Subbasal nerves and their branches were
traced and their lengths measured by using a custom program. Nerve density was expressed
as length of nerve per unit area (m/mm 2). Differences between pre-and post-operative nerve
densities were determined by using generalized estimating equation models (to account for
possible correlation between paired eyes) with Bonferroni correction for 4 comparisons.
Results: Mean subbasal nerve density before PRK was 6786 1948 m/mm 2 (SD).
Mean density decreased to 2764 1321 m/mm 2 (-59%, P<0.001) at 1 year. At 2 and 5
years, mean nerve density returned to 6242 1763 m/mm 2 (-8%) and 5903 3086
m/mm 2 (-13%) respectively, densities not signicantly different from densities before
PRK (P=1.0). Mean subbasal nerve density before LASIK was 5589 2436 m/mm 2.
Mean density was 2745 2913 m/mm 2 (-51%, P=0.001) at 1 year, 3661 2773 m/
mm 2 (-35%, P=0.03) at 2 years, and 3683 2517 m/mm 2 (-34%, P=0.006) at 3 years.
By 5 years after LASIK, density recovered to 4441 2819 m/mm 2 (-21%, P=0.58).
Conclusions: After LASIK, nerve ber bundles return to the subbasal layer more slowly
than they do after PRK.
CR: E.J. Winter, None; J.C. Erie, None; C.B. Nau, None; J.W. McLaren, None; D.O.
Hodge, None; W.M. Bourne, None.
Support: NIH Grant EY02037, Research to Prevent Blindness
4373 - B731
4374 - B732
Low-Contrast Visual Acuity and Small Letter Contrast Sensitivity in Adult Patients
With Refractive Error
A.M. Betts1,2, K.S. Bower1,2, D.K. Bigelow1,2, J.C. Rabin3, J.M. Burka1, R.C. VanRoekel1.
1
Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC;
2
Uniformed Services University of the Health Sciences, Bethesda, MD; 3College of
Optometry, Pacic University, Forest Grove, OR.
Purpose: To establish normative values for a low-contrast visual acuity (CA) test and a small
letter contrast sensitivity test (SLCT) in a sample of patients with refractive error. Methods:
Pre-op records of 438 patients who underwent refractive surgery at an Army laser center were
reviewed. 5% CA, SLCT score, manifest and cycloplegic refraction, and age were recorded
from each patients record. The distribution of scores for contrast testing was analyzed and
examined for correlations with age and refractive error. Results: The mean logarithmic 5%
CA was 0.34 for both right and left eyes (20/44 Snellen equivalent). The mean logarithmic
SLCT score was 0.38 (contrast threshold of 42%) for the right eyes and 0.40 (threshold 40%)
for the left eyes. The mean SLCT score was lower than previously reported. Higher levels of
myopia were associated with poorer performance on both tests. Neither test showed signicant
correlation with age in this sample. Conclusions: This retrospective review provides normative
values for two methods of contrast testing in a military refractive surgery clinic. The inverse
correlation between myopic refractive error and performance on contrast testing may be
attributed to optical effects of spectacle correction and/or retinal factors in myopic eyes. The
reduction in SLCT compared to previously established values is likely attributed to the nonstandard luminance conditions under which the SLCT was administered in this clinical setting.
CR: A.M. Betts, None; K.S. Bower, None; D.K. Bigelow, None; J.C. Rabin, None; J.M.
Burka, None; R.C. VanRoekel, None. Support: None.
4375 - B733
4376 - B734
Comparison of the Change in Corneal Higher Order Aberrations with WavefrontGuided Epi-LASIK versus Wavefront-Guided Conventional LASIK Using the
LadarWave CustomCornea Platform
J.J. Wong1, K.Masselam1, D.Jardim2, B.Soloway2, C.Starr1. 1New York University/
Manhattan Eye, Ear & Throat Hospital, New York, NY; 2New York Eye and Ear Inrmary,
New York, NY.
Purpose: To compare the efcacy of wavefront-guided epipolis laser in situ keratomileusis (Epi-LASIK)
versus wavefront-guided conventional LASIK in reducing high order aberrations (HOA) of the cornea.
Methods: Using the wavefront-guided CustomCor nea LadarWave system (Alcon
Laboratories Inc, Fort Worth, TX), eighteen eyes underwent Epi-LASIK using the
Moria Epi-K microkeratome (Moria Inc., Antony, France) and twelve eyes underwent
conventional LASIK. Wavefront analysis preoperatively, at 3 months, 4 months, and 6 months
postoperatively was performed with the iTrace Aberrometer (Tracey Inc., Houston, TX).
Results: Wavefront analysis showed the preoperative root mean squared (RMS) HOA for patients
undergoing LASIK to be 0.171 in the 3 month group, 1.137 in the 4 month group, and 0.192 in the
6 month group. In the Epi-LASIK group, the preoperative RMS HOA was 0.272 in the 3 month
group, 0.359 in the 4 month group, and 0.184 in the 6 month group. Overall, the preoperative RMS
HOA was 0.499 in the LASIK group and 0.322 in the Epi-LASIK group. Postoperatively, the RMS
change in high order aberrations (HOA) for the LASIK group was 0.079 at 3 months, -0.596
at 4 months, and 0.026 at 6 months. Postoperatively for the Epi-LASIK group, the RMS HOA
was 0.139 at 3 months, 0.128 at 4 months, and 0.087 at 6 months. Overall, the postoperative RMS
HOA was -0.188 for the LASIK group and 0.124 for the Epi-LASIK group. Thus, LASIK had a
signicantly higher decrease in HOA than Epi-LASIK(P<.05, independent t-test). However, there
was less follow up at 6 months with the Epi-LASIK group in contrast to the LASIK group. Plotting
HOA versus time, it was found that the LASIK group had a trendline with a positive slope (y =
0.029x - 0.2052) in contrast to a negative slope (y = -0.0284x + 0.2335) of the Epi-LASIK group.
Conclusions: In this preliminary study with limited follow-up, CustomCornea LASIK on average
induced fewer higher order aberrations than Epi-LASIK. However, a consistent trend towards
decreasing HOA over the 6 month follow-up was seen with Epi-LASIK and not LASIK. Longer
follow-up is needed to determine if this advantage of Epi-LASIK will continue.
CR: J.J. Wong, None; K. Masselam, None; D. Jardim, None; B. Soloway, AlconLabs C, R; C.
Starr, None.
Support: None.
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
4371-4376
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4377 - B735
4378 - B736
Nomogram for the Pre-Operative Prediction of Ablation Depth With Custom Cornea
Refractive Surgery
K.L. Masselam1, J.Wong1, D.Jardim2, D.Pettinelli1, B.Soloway2, C.Starr1,2. 1Ophthalmology,
New York University/Manhattan Eye, Ear and Throat Hospital, New York, NY;
2
Ophthalmology, New York Eye and Ear Inrmary, New York, NY.
Thin Corneas Undergoing Lasik 4 Years Follow Up Clinical and OCT 3 Analysis
B.A. Ameline1, M.G. Puech2, A.El Maftouhi1, E.A. Brasnu1, L.Laroche1. 1Hopital 15/20,
Paris, France; 2Centre Imagerie et Laser, Paris, France.
Purpose: The aim of this study was to evaluate the stability of thin corneas after Lasik procedures.
Methods: We retrospectively examined 12 eyes of 7 patients, who underwent a Lasik
procedure, from March 1998 to December 1999, even though their ultrasonic corneal
pachymetry ranged from 465 to 505 (Mean pachymetry 495.5 + 10.8). Their mean ametropia
was -6.55 + 3.14D. The maximum correction was -9 D. Corneal anterior topographies showed
no sign of keratoconus (Rabinowitz criteria) The ap was created with an ALKe (7 eyes)
or a Hansatome (5 eyes), Excimer ablation was performed with a Technolas 217c. Four
years later we studied their refraction and its stability, their keratometry by TMS2 and
Orbscan and we performed for each eye an OCT3 examination including the optical
measurement of their corneal pachymetry, ap thickness and residual posterior wall.
Results: At the nal examination 45% of the eyes were within 0.5 D of emetropia and
82% within 1.5 D. The myopic shift between the 6 month and four years end points was
0.62+0.63D. No eye lost more than one line of best corrected visual acuity. No corneal
ectasia was detectable with the Orbscan. Optical corneal pachymetry was comparable to
ultrasonic measurement (+6), whereas Orbscan underestimated the total pachymetry
by 49 in average. Optical measurement of the ap thickness ranged from 135 to 218
(M=169+25). Posterior wall was 264+44 in average, but ranged from 203 to 334.
Conclusions: OCT3 examination has allowed a retrospective in vivo analysis of the ap
thickness and residual stroma. None of our patients showed any sign of corneal ectasia during
a four years follow up even though the posterior wall could be as thin as 203.
CR: B.A. Ameline, None; M.G. Puech, None; A. El Maftouhi, None; E.A. Brasnu, None; L.
Laroche, None.
Support: None.
4379 - B737
4380 - B738
Purpose: To develop a novel nomogram for predicting the ablation depth of corneal-based
refractive surgery (LASIK and Epi-LASIK) using Alcons LadarWave CustomCornea platform.
Methods: In this retrospective study, a ratio of ablation depth in microns (u) perDiopter (D) of either spherical
equivalent (SE), sphere only (SO), or sphere plus cylinder (SC) was established in 45 eyes which underwent either
CustomCornea LASIK or Epi-LASIK. Average SE, SO, and SC were calculated and then divided into the average
ablation depth for all 45 eyes to determine three ratios (u/D). A sub-analysis compared the ratios of ablation depth
per diopter (SE, SO, SC) in 19 eyes with pre-op higher order aberrations (HOA) > 0.4u versus 26 eyes with pre-op
HOA < 0.4u. Higher order aberrations were assessed using the iTrace Aberrometer (Tracey Inc., Houston, TX).
Results: The average predicted ablation depth for all (45) eyes was 77. 1 u. Average SE, SO, and SC in all 45
eyes was -4.35 D, - 3.97 D, and -4.57 D, respectively. The ratio of ablation depth per diopter of SE, SO, and SC
was 17.7 u/D, 19.4 u/D and 16.9 u/D, respectively. The eyes were then sub-analyzed based on HOA, 19 eyes with
HOA > 0.4u (average 0.59u) and 26 eyes with HOA < 0.4u (average 0.25u). For 19 eyes with HOA > 0.4u, average
ablation depth was 89.8 u and for 26 eyes with HOA< 0.4u was 67.9 u. Average SE, SO, and SC for the increased
HOA group were -5.08D, -4.61 D, and -5.58 D, respectively. Average SE, SO, and SC for the lower HOA group
were -3.94 D, -3.64 D, and -4.25 D, respectively. Therefore, for the increased HOA group, the ratio of ablation
depth per diopter of SE, SO, and SC was 17.7 u/D, 19.5 u/D and 16.1 u/D, respectively, and for the lower HOA
group the ratio of ablation depth per diopter of SE, SO, and SC was 17.2 u/D, 18.6 u/D and 16.0 u/D, respectively.
Conclusions: A novel nomogram can be used in the ofce setting to predict ablation depth prior to customized
refractive surgery using Alcons LadarWave platform. The ratio of ablation depth per diopter ranged from
16.9 -19.4 u/D (average of 18.1 u/D) for all eyes. We found no signicant difference between the ratio of
ablation depth per diopter between the increased HOA group (16.1 - 19.5 u/D) and the lower HOA group (16.0
- 18.6 u/D). Using a nomogram of 18 microns of ablation per diopter of spherical equivalent, the refractive
surgeon can accurately predict the amount of corneal tissue to be removed at the time of surgery and avoid
post-operative complications including corneal ectasia.
CR: K.L. Masselam, None; J. Wong, None; D. Jardim, None; D. Pettinelli, None; B. Soloway, Alcon
Labs C, R; C. Starr, None.
Support: None.
4381 - B739
The Role of Restasis in Faster Visual Acuity Recovery After Refractive Surgery
R.Ursea, M.Lovaton, M.Ehrenhaus, B.Tan, C.Heichel, D.J. Schanzlin. University of
California San Diego, Shiley Eye Center, La Jolla, CA.
Purpose: Restasis (cyclosporine 0.05%, Allergan), is thought to improve tear
production and combat post-LASIK inammation. Our aim in this study was to compare
refractive outcome and complications following LASIK in a group of 54 patients
treated with Restasis (Cyclosporine 0.03%) in addition to the usual topical steroids
and antibiotic drops versus a control group of 46 subjects not receiving Restasis.
Methods: Retrospective analysis of one hundred patients underwent Lasik correction
for different refractive errors. Patients underwent a complete ophthalmic examination
prior to the procedure for evidence of dry eyes. All patients in this series were initially
evaluated with best corrected visual acuity, complete slit lamp biomicroscopy and
dilated fundus examination, Schirmer test, tear break-up time, uorescein and rose
Bengal staining. They answered a questionnaire regarding dry eyes complains before
and 6 weeks after the refractive surgery. Restasis was added to the postoperatory drops
regimen in 54 patients. Results were compared with patients that did not receive Restasis.
Results: Our 100 patients consisted of 54 females and 46 males, with an age ranging from 22
to 69 years. Fifty-four patients were treated with Restasis. At the onset of Restasis therapy
63% patients had complains of dry eyes. Almost half (25 patients, 46.3%) achieved 20/15
vision at one week after surgery, 21 patients (38.9%) had 20/20 vision and 8 patients (14.8%)
had worse than 20/25. In the group of 46 patients not receiving Restasis, the majority (26
patients, 56.5%) did not improve to better than 20/25 at 1 week postop. During the course
of therapy none of the patients reported adverse effects to the use of Restasis. Patients
using Restasis were signicantly more likely than patients who did not use Restasis to have
20/15 vision (P=.017). Patients who did not use Restasis were signicantly more likely
than patients who did use Restasis to have a visual outcome worse than 20/20 (P<.001).
Conclusions: Restasis might be effective in fast visual recovery after refractive surgery,
besides improving the dry eyes syndrome. Future studies are required to determine longterm efcacy of Restasis in maintaining a good visual acuity and in treating dry eyes and if
higher Restasis doses are required and well-tolerated.
CR: R. Ursea, None; M. Lovaton, None; M. Ehrenhaus, None; B. Tan, None; C. Heichel,
None; D.J. Schanzlin, None.
Support: None.
Purpose: To report the management of a severe corneal scar at the LASIK ap interface using lamellar keratoplasty
with a Hansatome microkeratome and subsequent LASIK enhancement to correct residual astigmatism.
Methods: Case report of a 56-year-old man who developed a severe Pseudomonas corneal ulcer
two years after uncomplicated LASIK surgery. On presentation, visual acuity in the affected eye
was light perception only; hypopyon and severe DLK were noted. The corneal ulcer resolved after
aggressive treatment with fortied antibiotics as well as topical and oral steroids. However, a dense
corneal scar at the level of the LASIK ap interface resulted and extended into the visual axis.
A lamellar keratoplasty was performed to remove the corneal scar at the LASIK ap interface. Using
standard technique with a Hansatome microkeratome (Bausch & Lomb), a 180 micron ap was created to
remove the old LASIK ap and the corneal scar from the previous infection. A donor ap from a whole globe
was created using an identical Hansatome microkeratome arrangement. A superior hinge was then cut in
the host and in the donor tissue. The donor ap was sutured to the host stromal bed, with the superior hinge
well matched. Postoperatively, the eye was treated with a bandage contact lens, antibiotics and steroids.
Results: At post-operative week one, the transplanted LASIK ap was completely epithelialized.
There was no evidence of epithelial ingrowth. Selective suture removal began at post-op week
three. Residual corneal astigmatism (4.5 D) was later treated with standard LASIK enhancement
technique by lifting the transplanted lamellar ap. Post-op management included standard bandage
lens and antibiotic therapy. At post-enhancement week one the ap was well positioned and
there was no evidence of striae or epithelial ingrowth. Post LASIK enhancement VA was 20/40.
Conclusions: Bacterial corneal ulcer occurring after LASIK surgery may result in severe interface
scar with signicant decrease in vision. Using a standard Hansatome microkeratome set-up, lamellar
keratoplasty can be successfully performed to eliminate the interface scar. This approach offers faster
visual recovery than penetrating keratoplasty and provides the potential for post-transplant LASIK
enhancement. In addition, the requirement for eye bank tissue is less strict, as the tissue may be
obtained from a frozen globe.
CR: E.P. Herlihy, None; P.N. Youssef, None; M.V. Netto, None; T.T. Shen, None.
Support: None.
4382 - B740
Tear Film Function and Corneal Sensation After LASEK for the Correction of
Myopia
W.A. Herrmann1, C.P. Lohmann2, C.P. Shah3, K.Hufendiek1, C.Winkler von Mohrenfels2,
V.-P.Gabel1. 1Ophthalmology, University Eye Clinic, Regensburg, Germany;
2
Ophthalmology, University Eye Clinic, Technische Universitt Mnchen, Germany;
3
School of Medicine and Denstristry, University of Rochester, Rochester, NY.
Purpose: Corneal nerves are damaged during LASEK surgery. This leads to a reduction
of corneal sensation and to alterations of the tear lm function. The aim of this study
was to evaluate tear lm function, corneal sensation and subjective symptoms of
a dry eye in the early postoperative period after LASEK for the correction of myopia.
Methods: LASEK surgery was performed in 20 eyes of 10 consecutive patients for the correction
of myopia(-1.0 D to -8.0 D, mean -4.86 D). Subjective symptoms of a dry eye were evaluated
with a standardized questionnaire. Schirmer Test without local anaesthesia, tear lm breakup
time, uorescein staining of the cornea and corneal esthesiometry (Cochet Bonnet) were
performed before surgery and 3 days, 1 week, 1 month, 2 months and 3 months after LASEK.
Results: Corneal sensation is reduced 3 days and 1 week after LASEK and recovers
during the 1 month after LASEK. The tear lm breakup time is reduced after LASEK
and reaches preoperative values 2 months after surgery. Fluorescein staining was
increased 3 days and 1 week after LASEK. Subjective symptoms of a dry eye were
increased during the rst 2 months after LASEK. Concerning the Schirmer Test no
signicant changes were assessed after surgery as compared to preoperative values.
Conclusions: LASEK surgery alters tear lm function and reduces corneal sensation in the
early postoperative period. Subjective symptoms of a dry eye were described during the
rst 2 months after surgery. 3 months after LASEK no statistically signicant changes were
observed concerning the assessed parameters as compared to preoperative values.
CR: W.A. Herrmann, None; C.P. Lohmann, None; C.P. Shah, None; K. Hufendiek,
None; C. Winkler von Mohrenfels, None; V. Gabel, None.
Support: None.
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43774382
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4383 - B741
Purpose: To compare the results of clinical vision tests with patient perception of vision following wavefrontguided LASIK, and to determine how closely and under what circumstances perception correlated with test results.
Methods: Wavefront-guided LASIK was performed on myopic-astigmatic eyes at 6 clinical sites.
Questionnaires were administered and comprehensive vision evaluations were conducted before and 6 months
after surgery. Questionnaire responses were compared with test results using ordinal logistic regression.
Results: Two hundred seventy-four eyes completed 6 months of follow-up. After surgery, the very satised
responses increased in all areas by as much as 70%. Improved visual performance was consistently reected both
perceptually and in test scores. However, patients were more vocal if they experienced decreases in vision. Preop magnitude of myopia had minimal inuence on questionnaire outcome (p>0.05), but post-op refractive error
was a signicant predictor for the majority of the questionnaire items (p<0.01 or 0.05). Day vision experience,
i.e., sharpness, and daily visual uctuation, was inuenced by uncorrected visual acuity and post-op Rx (p<0.01
or 0.05). Night vision experience was inuenced by post-op Rx and mesopic glare contrast sensitivity (CS)
(p<0.01). Additionally, the perception of changes in vision seems to be related to mesopic CS and mesopic CS
under glare (p<0.01 or 0.05). Mesopic pupil diameter was not a major predictor of visual experience (p>0.05).
Male patients were more likely to report frequent visual symptoms and voiced stronger complaints regarding
night vision (p<0.01). However, according to their questionnaire scores, the changes in the male subjects vision
were the same as the changes in their female counterparts. In addition, subjects who used contact lenses prior
to surgery were more satised with their post-operative vision than subjects who had worn spectacles (p<0.05).
Conclusions: Results suggest that in addition to objective visual outcomes, subjective factors affect
questionnaire responses. Patients who experienced visual degradation were more expressive of their displeasure.
In addition, the patients sex and the type of corrective lens used before surgery may be factors in subjective
responses. Night vision complaints were corroborated by mesopic contrast testing and post-operative refractive
error. Undesirable visual experiences could be reduced and patient satisfaction maximized if post-operative
refractive error can be minimized and the overall optical quality of the eyes improved.
CR: K.A. Tuan, VISX, Incorporated E.
Support: VISX, Incorporated
4385 - B743
4384 - B742
4386 - B744
4387 - B745
4388 - B746
Central Epithelial and Stromal Thickness 5 Years After LASIK and PRK
C.B. Nau1A, J.C. Erie1A, D.O. Hodge1B, J.W. McLaren1A, W.M. Bourne1A. ADepartment
of Ophthalmology, BDepartment of Biostatistics, 1Mayo Clinic College of Medicine,
Rochester, MN.
Purpose: To examine changes in epithelial and stromal thickness for 5 years after
LASIK (laser in situ keratomileusis) and PRK (photorefractive keratectomy).
Methods: Seventeen eyes of 11 patients were treated with LASIK to correct refractive errors
between -2D and -11D. Stromas were cut with a Hansatome microkeratome with a planned
180 m-depth. Eighteen eyes of 12 patients were treated with PRK to correct refractive errors
between -1.5D and -5.75D. Central corneas were examined by confocal microscopy (Tandem
Scanning, Reston, VA) before and at 1 month, 3 months, 6 months, 1 year, 2 years, 3 years,
and 5 years after the procedure. Epithelial thickness was determined from the number of video
frames between the brightest image of epithelial cells and either the subbasal nerve plexus
or the intensity peak just anterior to the rst keratocytes if nerves were not visible. If neither
endpoint was present after LASIK, thickness was not determined. If neither was present after
PRK, the rst frame of anterior keratocytes was used as the endpoint. Epithelial thicknesses
after treatment were compared to thickness before treatment, and stromal thicknesses were
compared to stromal thickness at 1 month. Signicances of differences were determined by
using Generalized Estimating Equation models (to account for potential correlation between
eyes from the same patient) and the Bonferroni method to correct for multiple comparisons.
Results: Mean epithelial thickness before LASIK was 41 4 m ( SD, n=17). It increased to
50 5 m at 1 month (p<0.001, n=12) and 53 5 m (p<0.001, n=16) at 5 years. Mean stromal
thickness was 391 39 m (n=17) one month after LASIK, and 393 31m (p=1.0, n=16) at
5 years. Mean epithelial thickness before PRK was 44 5 m (n=18). At 5 years it was 45 5
m (p=1.0, n=18), although at 3 years it had increased to 49 7 m (p<0.001, n=18). Stromal
thickness was 395 41 m (n=15) 1 month after PRK, and 416 47 m (p=0.12, n=18) by 5 years.
Conclusions: Epithelial thickness increases after LASIK and remains elevated for at least
5 years. The stroma does not thicken or thin during the same time, after the initial surgical
reduction. After PRK the epithelial and stromal thicknesses do not change for at least 5
years.
CR: C.B. Nau, None; J.C. Erie, None; D.O. Hodge, None; J.W. McLaren, None; W.M.
Bourne, None.
Support: NIH Grant EY02037, Research to Prevent Blindness, Inc.
Dry Eye Symptoms and Corneal Sensitivity Following LASIK for High Myopia
T.Tervo. Helsinki Univ Eye Hospital, University of Helsinki, Helsinki, Finland.
Purpose: To assess subjective symptoms and objective clinical signs of dry
eye and corneal sensitivity after > 10 D myopic LASIK., and to correlate
the severity of dry eye symptoms with corneal sensitivity threshold values.
Methods and subjects: Twenty eyes of 20 patients (mean age 34 + 7.5 years), who had
undergone > 10 D myopic LASIK two to ve years earlier, were enrolled in the study.
Clinical objective signs of dry eye in addition to normal ophthalmic examination and a
subjective dry eye questionnaire were used to harvest the data. The central corneal
mechanical sensitivity was assessed with a modied Belmonte Non-Contact Esthesiometer.
Results: The preoperative refraction (spherical equivalent; SE) was -11.4+1.4 D (mean +
SD) and the intended correction SE was -10.4+1.1 D. Postoperatively, the mean manifest
refraction was -1.9 + 1.6. The mean UCVA was 10/20 and BCVA 20/20. The postoperative
Schirmer I test value was 14.4 + 8.9 mm and 6.9 mm + 4.9 mm in controls and BUT 15.9 +
11.2 s and 17.0 + 11.0 s, respectively. The majority of the patients still complained about dry
eye symptoms (60%), glare and halos (80 %) under scotopic conditions. However, almost all
of the patients (95 %) were generally satised and would have chosen the surgery again. The
mean postoperative mechanical corneal sensitivity (treshold) was 73.5 + 29.6 ml/min and 77.5
+ 18.3 ml/min (p=0.97) in the controls. Ocular surface disease index (OSDI) score, indicating
degree of dry eye symptoms, was signicantly higher in LASIK patients (18.6 + 13.4) compared
to control individuals (5.2 + 7.6 ;p < 0.05). Anecdotally, we also observed postoperative
hypersensitivity in a patient, who had undergone an unilateral 9 D PRK of D 8 years earlier.
Conclusions: Corneal mechanical sensitivity threshold values had returned to normal level 2-5
years following LASIK for correction of high myopia . Despite the reported high prevalence of
dry eye symptoms, objective clinical signs of dry eye were rare. Abnormal neural regeneration
and/or irritability may account for some of the dry eye symptoms that persist years after
correction of high myopia with LASIK.
CR: T. Tervo, None.
Support: HUS EVO grant
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43834388
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4389 - B747
4390 - B748
4391 - B749
4392 - B750
Purpose: To compare the outcomes of laser in situ keratomileusis (LASIK) performed by residents and
fellows with those of cornea trained faculty members at an academic ophthalmology training program.
Methods: A retrospective cohort study was conducted of all myopic LASIK cases performed by residents
or fellows (trainees) between 1/1/99 and1/15/04 at the University of California, San Francisco. Cases
performed by trainees were compared with age-matched and preoperative spherical equivalent-matched
faculty-performed cases. The primary endpoint was the percent of eyes achieving uncorrected visual
acuity (UCVA) of 20/25 or better at 1 month. Secondary endpoints were percent of eyes achieving UCVA
of 20/20 or better, percent of eyes attaining UCVA of 20/40 or better, postoperative refractive error,
complication rates, enhancement/reoperation rates, and percent of eyes losing 1 or more lines of BSCVA.
Results: A total of 124 trainee and 108 faculty cases were identied. Trainee and faculty cases were comparable
in age, sex, mean age, mean follow-up, and baseline refractive error. At 1 month follow-up, UCVA of 20/25
or better was achieved in 71% of trainee and 79% of faculty cases (p=0.02), UCVA 20/20 or better attained
in 50% of trainee and 65% of faculty cases (p=0.01), and UCVA 20/40 or better achieved in 91% of trainee
and 94% of faculty cases (p=0.12). Residual refractive error was similar between groups. The incidence of
microkeratome complications and any observable epithelial ingrowth, diffuse lamellar keratitis, or microstriae,
regardless of clinical severity, was 36% in trainee vs. 27% in faculty cases (p = 0.02), but severe complications
(microkeratome-related and those requiring reoat) occurred only in trainee cases (4% vs. 0% in faculty cases).
Enhancement/reoperation was performed in 16% of trainee and 10% of faculty cases (p<0.01). One-line loss of
BSCVA occurred in 7% of trainee and 9% of faculty cases (NS); neither group lost 2 or more lines of BSCVA.
Conclusions: Patients undergoing LASIK by a resident or fellow were less likely to achieve 20/20 or 20/25
UCVA, more likely to experience postoperative complications, and more likely to require enhancement/
reoperation when compared to cases performed by fellowship-trained faculty. Residual refractive error and
frequency of loss of BSCVA was comparable between the groups. Patients should be appropriately counseled
on the outcomes of LASIK performed by trainees.
CR: M.M. Lai, None; P.K. Sangani, None; D.G. Hwang, None.
Support: Unrestricted grant from Research to Prevent Blindness
4393 - B751
Purpose: This paper reports early changes in the surface shape of two eyes of the same subject
following wavefront-guided PRK treatments for refractive error. The asymmetry of epithelial
recovery and the interaction between the uneven epithelium and the tear lm were closely observed.
Me t ho d s : Me a s u r e me nt s a r e r e p or t e d for c or ne a l t op og r aphy u si ng a
Hu mph rey Atlas device, wavef ront aber romet r y usi ng a V ISX WaveSca n
device, and cor neal and epithelial thick ness using a Haag-Streit Pachymeter.
Corneal topography measurements were begun four days after treatment, a few hours after the bandage
contact lens was removed, and were continued several times per week for seven weeks. The data
gathered by the topographer were analyzed by purpose-written MatLab programs that determined
the corneal shape changes both on a day-by-day basis and relative to the intended post-treatment
shape. During these examinations the mire images were used to observe post-blink changes in the
tear lm as the initially formed tear lm owed to even out underlying epithelial layer irregularities.
Wavefront aberrometry and corneal and epithelial thickness measurements were used as complements
to the corneal topography measurements to construct an overall picture of the shape of the surface
of the eye. Changes on the order of microns could be observed so that day-to-day variation of
the surface shape could be distinguished, especially during the very early stages of recovery.
Results: The tear film can replicate a very irregular underlying surface, but between
blinks the lm changes to smooth its own surface. The epithelial layer initially thickens
preferentially in the nasal and temporal periphery so that astigmatism is induced.
Differential epithelial thickening took place primarily in a brief period between the 6 th and
8th days post-operatively. The differential peripheral thickening was of the order of 3-4 m.
Conclusions: By combining corneal topography, wavefront aberrometry and pachymetry the early
stage recovery of the surface of the eye following PRK surgery can be followed with high resolution
allowing day-to-day changes to be mapped and the dynamics of the tear lm to be studied.
CR: K. Holliday, VISX, Incorporated E; C.E. Campbell, VISX, Incorporated C.
Support: None.
4394 - B752
Refractive Results After LASIK With Esiris Excimer Laser - Investigation of the Flap
Thickness of 140 m compared to 160 m
G.Unger, D.Sandner, D.Langner, T.Baier, M.Kohlhaas, L.E. Pillunat. Ophthalmology,
University Eye Clinic, Dresden, Germany.
Purpose: To avoid an iatrogene Keratectasie after LASIK the remaining thickness of
the stroma has to be 250 m. In cases that need higher corrections and have a primary
smaller corneal thickness a thinner ap is desired to to keep more stroma for ablation.
The
possible
inf luence
of
the
thinner
f lap
thick ness
for
f unctionell
and
ref ract ive
results
was
i nvest igated.
Methods: During the period from 03/04 to 06/04 14 eyes of 7 patients (mean age of 32 years) was
performed in LASIK with the Esiris Excimer Laser. The Amadeus microceratom was used to cut
the ap. 0n the right eyes a ap thickness of 160m were chosen on the partner eyes one of 140m.
The preoperative mean spherical equivalent was -5.35 D (SD 2,22 D; -8,25 D to
-2,0 D) in the 140m ap thickness group vs -4,94 D (SD -2,43 D; -8,75 D to 1.75 D) in the 160m ap thickness group. All treatments were realized to same
standards and were nished succesfully. Postoperative complications didnt occur.
Results: With both aps a slight undercorrection could be observed which stayed stable during
follow-up. There was no signicant difference between both groups (-0,63D vs -0,67D). In
comparison, in 55% (vs 67%) visual acuity remained the same, in 18% (vs 17%) visual acuity
improved by one line and in 27% (vs 17%) there was a reduction of best corrected visual
acuity by one line in eyes treated with a 140m (vs 160m). 69% of the eyes in the 160 m
ap-group showed a uncorrected visual acuity of 0,8 or better vs 85% in the 140m ap-group.
Conclusions: There is no increase in complications while performing LASIK with a ap
thickness of 140m. Occurance of corneal striae was not observed more often with 140m
aps. In tendency, the risk for a reduction in visual acuity is slightly lower with a ap thickness
of 160m, but the chance of an improvement in visual acuity and of reaching a best corrected
visual acuity of 0,8 or better is higher with a ap thickness of 140m.
CR: G. Unger, None; D. Sandner, None; D. Langner, None; T. Baier, None; M. Kohlhaas,
None; L.E. Pillunat, None.
Support: None.
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
43894394
Wednesday, May 4, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 4335-4395 / B693-B753
454. Refractive Surgery Organizing Section: CO
4395 - B753
Copyright 2005 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Ofce at pubs@arvo.org.
Commercial Relationships are noted at the end of each abstract by None or with codes.
4395