Transcript Clinical Outcomes of Epi-LASIK for Myopia in

Early Clinical Outcomes of
Epi-LASIK for Myopia in Taiwan
台灣諾貝爾醫療集團
張朝凱醫師.陳美齡醫師.王倫奕醫師.劉淳熙醫師.
張鼎業醫師.林玉凰醫師.戴文瑛醫師.蕭清仁博士
2006年10月28日
中國廈門屈光手術研討會
Surface Ablation
This year( 2006 ) we went
B to B
Back to Bowman’s
2006年10月28日
中國廈門屈光手術研討會
Back to Bowman’s
There has been a significant movement back
to surface ablation.
Major recent improvements in surface
ablation include gradual blend zones and
Mitomycin C for haze.
2006年10月28日
中國廈門屈光手術研討會
Surface Ablation
Concerns for Lamellar Ablation
– Deeper ablations due to larger ablation
zones
– Increased concern of ectasia
– Improved visual results?
No flap related aberrations
Bowman’s membrane a more regular canvas
than stroma
2006年10月28日
中國廈門屈光手術研討會
Surface Ablation
Indications
– Thin corneas
– Patients predisposed to ocular trauma
– Detachment surgery
– Glaucoma
– Flat corneas
– Steep corneas
– Deep-set eyes
2006年10月28日
中國廈門屈光手術研討會
Surface Ablation
Relative to Lamellar ablation
– No flap related complications
No striae
Less dry eye
No irregular flaps
No DLK
2006年10月28日
中國廈門屈光手術研討會
Purpose
To evaluate initial clinical outcome
with Epi-LASIK for myopia with
astigmatism
2006年10月28日
中國廈門屈光手術研討會
Methods
Three months results from a cohort of 56
eyes ( 30 patients ) that had Epi-LASIK
procedures with and without Flap Removal
as well as PRK were studied .All
operations were done with Amadeus 2
( AMO, Santa Ana ,CA , USA ).
2006年10月28日
中國廈門屈光手術研討會
Methods
For Epi-LASIK,epithelial separation was achieved
mechanically without the use of alcohol.
The epithelial flap was remained (Option1) or
removed (Option 2) and a therapeutic contact
lens was applied to the cornea immediately for 3
to 5 days.
PRK patients were as usual
Postoperative epithelial defect size , symptoms,
UCVA, BCVA were evaluated at three months
postoperatively.
2006年10月28日
中國廈門屈光手術研討會
Methods
Surgical Parameters
–
Oscillation speed: 11,000 rpm
–
Translation speed: 1.5 mm/sec
–
Suction: 22 mm Hg
–
Epithelial removal 9.0 mm
2006年10月28日
中國廈門屈光手術研討會
Epi-LASIK
2006年10月28日
中國廈門屈光手術研討會
What is Surface Ablation (Epi Lasik) ?
Compare pig eye and human eye
2006年10月28日
中國廈門屈光手術研討會
Option 1 (Flap Remain)
2006年10月28日
中國廈門屈光手術研討會
Option 2 (Flap Removal)
2006年10月28日
中國廈門屈光手術研討會
Methods
Epithelial defect size was measured with the slit lamp and
recorded with digital photography daily until epithelial
defects healed
Post-operative symptoms , UCVA, BCVA were studied
All patients received postoperative 0.1 FML qid for 3 weeks,
Ciloxan qid for 1 week,, and BSS qid for over 6 weeks
Bandage contact lenses were removed after 4 days and
corneas were stained with fluorescein
2006年10月28日
中國廈門屈光手術研討會
Results
1.Epithelial Defect Size
2.Postoperative symptoms
3.UCVA
4.BCVA
2006年10月28日
中國廈門屈光手術研討會
1.Epithelial Defect Size (mm)
Following Epi-LASIK, with and
without Flap Removal, and PRK
10
9
8
7
6
Flap Remain
Flap Removal
PRK
5
4
3
2
1
0
Day 1
Day 3
Day 5
2006年10月28日
中國廈門屈光手術研討會
Patient 1(Epi - LASIK)
手術後第1天
手術後第3天
手術後第2天
手術後第5天
2006年10月28日
中國廈門屈光手術研討會
Patient 2 (PRK)
手術後第1天
手術後第5天
手術後第3天
手術後第7天
2006年10月28日
中國廈門屈光手術研討會
Fluorescing Stain
Flap removal 24 hours
PRK 24 hours
Flap removal 48 hours
PRK 48 hours
2006年10月28日
中國廈門屈光手術研討會
Flap removal 72 hours
PRK 72 hours
2.Pain Following Epi-LASIK, with
and without Flap Removal, and
PRK
10
9
8
7
6
Flap Remain
Flap Removal
PRK
5
4
3
2
1
0
Day 1
Day 3
Day 7
Pain significantly greater with PRK on day 1 and 3
2006年10月28日
中國廈門屈光手術研討會
3.UCVA Following Epi-LASIK,
with and without Flap Removal,
and PRK
65
55
Flap Remain
Flap Removal
PRK
45
35
25
15
Day 3
Day 7
Month 1
UCVA significantly better with flap removal on day 3 and 7
2006年10月28日
中國廈門屈光手術研討會
4.BCVA Following Epi-LASIK,
with and without Flap Removal,
and PRK
65
55
Flap Remain
Flap Removal
PRK
45
35
25
15
Day 3
Day 7
Month 1
BCVA significantly better with flap removal on day 3 and 7
2006年10月28日
中國廈門屈光手術研討會
Discussion 1
What are the advantages of
Surface Ablation compared with Lasik?
• He can do higher correction on thin cornea.
• No stroma is leaving on the flap.
• No cut through the stroma
• Less risk by doing the flap
2006年10月28日
中國廈門屈光手術研討會
Discussion 2
Why is Surface Ablation not always used?
• In average patients have more pain during the first 5 days post
OP.
• It is a little more difficult to handle a Surface Ablation flap than
a Lasik Flap.
Surface Ablation does not substitute the Lasik:
• Surface Ablation is a complementary method to Lasik.
• Because of the wider range of possible patients, Doctor can
operate about 12-17% more patients if he can use both
systems.
2006年10月28日
中國廈門屈光手術研討會
Discussion 3
The most important initial event following
surface ablation is for the corneal
epithelium to heal as rapidly as possible as
the outcome of surface ablation is closely
related to the epithelial wound healing
response.1
1Fagerholm
P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg
2000.
2006年10月28日
中國廈門屈光手術研討會
Discussion 4
Delayed re-epithelialization increases
– Time for visual rehabilitation
– Incidence of postoperative haze
– Pain and photophobia
– Risk of infectious keratitis
1Fagerholm
P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg
2000.
2006年10月28日
中國廈門屈光手術研討會
Discussion 1
Epi –LASIK -Mechanical separation without alcohol
preserves the integrity of the epithelium and stroma.
Partners well with wavefront-guided custom
ablation.
This may allow for improved:
 Comfort
 Predictability
 Visual recovery.
2006年10月28日
中國廈門屈光手術研討會
Conclusion 1
Epi-LASIK with the Amadeus II
microkeratome removes the entire
corneal epithelial layer with no
discernible damage to the removed
tissue or damage to Bowman’s
membrane.
2006年10月28日
中國廈門屈光手術研討會
Conclusion 2
Epi-LASIK (with flap remain) with the
Amadeus II microkeratome provides
greater patient comfort than PRK or EpiLASIK (with flap removal) during the
immediate post-operative period
2006年10月28日
中國廈門屈光手術研討會
Conclusion 3
Epi-LASIK (with flap removal) with the
Amadeus II microkeratome provides
more rapid visual rehabilitation than
PRK or Epi-LASIK (with flap remain)
during the immediate post-operative
period
2006年10月28日
中國廈門屈光手術研討會
Conclusion 4
We need long term studies to evaluate
the efficacy of Epi-LASIK looking at
– BCVA/UCVA
– Corneal Haze
– Corneal Sensitivity and Tear Function (AJO
Volime 142 , issue 4 , Oct 2006)
– Quality of vision and high order aberrations
2006年10月28日
中國廈門屈光手術研討會
CONCLUSION
Epilasik for
moderate to high
myopia with the
Amadeus II
Epikeratome
Thank
you
– Safe
– Reproducible
– Good patient
satisfaction
2006年10月28日
中國廈門屈光手術研討會