E-Poster Rio de Janeiro Corneal Tomography and Biomechanics Study Group e-Poster Rio de Janeiro...

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Rio de Janeiro Rio de Janeiro Corneal Corneal

Tomography andTomography andBiomechanicsBiomechanicsStudy GroupStudy Group

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Epi-Lasik Versus Epi-Lasik Versus PTK Epithelial PTK Epithelial Removal: Removal: Contralateral Eye Contralateral Eye StudyStudyDaniela Jardim, MD; Gustavo

Bonfadini, MD; Frederico Guerra, MD; Fernanda

Fonyat, MDBruno Valbon, MD; Renato Ambrosio JR

MD, PhD Rio de Janeiro - Brasil

Dr. Ambrósio is a consultant for Oculus and is on the speaker bureau for Reichert, Allergan, Alcon and Moria.

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Rio de Janeiro Corneal Rio de Janeiro Corneal TomograhyTomograhy

and Biomechanics Study and Biomechanics Study GroupGroupRenato Ambrosio Jr, MD, Renato Ambrosio Jr, MD,

PhDPhDMarcella Salomão, MDMarcella Salomão, MDFrederico Guerra, MDFrederico Guerra, MD

Daniela Jardim, MDDaniela Jardim, MDBruno Valbon, MDBruno Valbon, MD

Gustavo Bonfadini, MDGustavo Bonfadini, MDSimone Boghosian, MDSimone Boghosian, MDRenata S. Siqueira, MDRenata S. Siqueira, MDFernanda Fonyat, MDFernanda Fonyat, MDRicardo Valente, MDRicardo Valente, MDRuiz Simonato, MD Ruiz Simonato, MD

Bruno M. Fontes, MDBruno M. Fontes, MD

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LASIKAdvantages

Faster Visual Rehabilitation (“Wow factor”)High Comfort Level Lower risk of Corneal InfectionsBetter for Enhancements

DisadvantagesFlap ComplicationsDLKNeurotrophic Epitheliopathy and Dry Eye Risk of more complex Corneal InfectionsIatrogenic Keratectasia

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Why Surface Ablation?No Flap related ComplicationsLess Biomechanical Impact on the Cornea Minor Impact on Ocular Surface after Epithelial HealingBetter registration of custom treatmentsImprovements on Corneal Ablations and Wound Healing modulation to decrease HazeBUT, still has slower visual rehabilitation and discomfort during the first two to seven days

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How to do for Surface Ablation?

Traditional Manual Epithelial Traditional Manual Epithelial ScrapeScrapeAlcohol-assisted Epithelial removalAlcohol-assisted Epithelial removalLASEKLASEKEpi LASIKEpi LASIKTransepithelial PTK-PRKTransepithelial PTK-PRK

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Epi-LASIK ConceptEpithelial flap (No alcohol )Epithelial flap (No alcohol )

Minimal pharmacological or chemical exposure to the epithelium

More vital epithelial layer allowed for less pain and speedier recovery.

Alcohol has a sinergic effect for keratocyte Alcohol has a sinergic effect for keratocyte depletion with mitomycin Cdepletion with mitomycin CCleavage principleCleavage principle

Angle of blade to epithelium allows for cleavage of the epithelial layer without cutting

Cleavage follows along plane of least resistance by separating and rupturing this plane

Cleavage at the level of the basement membrane appears to allow for a viable epithelial layer

Implications of better wound healing?* Pallikaris, IG et al. Epi-LASIK: Comparative histological evaluation of mechanical and Alcohol-assisted epithelial separation. J Cataract Refract Surg 2003; 29:1496-1501

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Epi-LASIK x ePTK (Laser Epithelial

Removal)

ePTK – PRK (Allegretto ePTK – PRK (Allegretto Eye Q)Eye Q)

Epi-LASIKEpi-LASIK

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Epi-LASIK x ePTK :VISUAL RECOVERY AND

SUBJECTIVE PER AND POST-OPERATIVE DISCOMFORT

Contralateral eye prospective studyContralateral eye prospective studySo far: 11 patients (22 eyes)So far: 11 patients (22 eyes)Range from -1.75 to -8.00 (S.E.)Range from -1.75 to -8.00 (S.E.)All Eyes had epithelial healing by day 5All Eyes had epithelial healing by day 5Low scores of pain and discomfortLow scores of pain and discomfort4/5 preferred e-PTK procedure 4/5 preferred e-PTK procedure 3/5 preferred Epi-LASIK in the first 4 to 72 3/5 preferred Epi-LASIK in the first 4 to 72 hourshoursAll cases had 20/40 or better UCVA after All cases had 20/40 or better UCVA after CLs removalCLs removal

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Which eye do you prefer? DURING

PROCEDURE

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Which eye do you prefer?

FIRST DAY POST-OP

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Subjective Discomfort Subjective Discomfort Level Level Comparison on ePTK x Comparison on ePTK x

EpiLASIK EpiLASIK (during surgery and first week)(during surgery and first week)

0

1

2

3

4

5

During Surgery

D1 D2 D3 D4 D5

EpiLASIK

e-PTK

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ConclusionAdvanced Surface Ablation can be performed by different waysWe believe that epithelial flap formation with EpiLASIK and epithelial ablation with the PTK mode are the best choices today During the surgery, most patients preferred the epithelial ablation with the PTK mode procedure. However Epi-Lasik provided less discomfort in the first three days after surgery. Either techniques provided good outcomes. Long term follow up is needed, along with a bigger sample to elucidate if there is any differences in terms of haze formation and vision quality.

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