Femto laser asisted I.C.R implantation in treatment of ... - RM Solutions

11/18/2012
Femto laser assisted I.C.R
implantation in treatment of
keratoconus
Tarek Salah, M.D. FRCS
Mohamed Gamal , M.D.
Demographic data
• 41 eyes of 32 patients
• 21 male , 11 female
• Age: average 29.4 (18-44 years)
• 9 patients had bilateral surgery
• 37 case kc
• 2 cases post lasik ectasia
• 2 cases PMD
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11/18/2012
Patient selection
• CL intolerable
• BSCVA : < 20/50
• Pachmetry : > 400 um at 5 mm zone
• Clear cornea
• No collagen disorder
• No ocular active disease
Preoperative & postoperative
exam:
• UCVA
• BSCVA
• Manifest sphere & cylinder refraction
• Spherical equivalent
• Keratometry
• Corneal topography (pentacam)
• Pachymetry (pentacam thickness profile at 5mm zone)
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11/18/2012
Preoperative data
Median Min Max
UCVA 20/200 Cf 2m 20/50
BSCVA 20/80 20/400 20/25
Spherical
equivalent
-6.25 -1.00 -12.00
Average K 48.9 45.4 56.00
K max 54.8 48.1 61.6
Surgical procedure
• Femto second laser FS 200 (Alcon)
• Corneal tunnel:
-Incision : *Length :1.0 mm
*Location: steep axis
-Tunnel : *Outer diameter: 6.0 mm
*Inner diameter: 4.90 mm
*Depth : 80 %
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11/18/2012
Screen shot
Surgical procedure
ICR (Ferrara ring)
• Outer diameter : 6.00 mm
• Inner diameter : 5.00 mm
• Modified manufacture nomogram
*Thickness
*Arc length
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SL photo
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Change in UCVA
Median Max Min
preoperative 20/200 20/50 Cf 2m
1 week 20/60 20/25 20/200
1 month 20/70 20/25 20/200
6 month 20/50 20/25 20/100
250
200
change in UCVA
150
100
change in UCVA
50
0
pre op 1 wk 1 month 6 month
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Change in BSCVA
Median Max Min
preoperative 20/80 20/25 20/400
1 week 20/40 20/25 20/100
1 month 20/50 20/20 20/100
6 month 20/40 20/30 20/70
100
change in BSCVA
80
60
40
change in BSCVA
20
0
preop 1 wk 1 month 6 month
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11/18/2012
Change in BSCVA
18
16
14
12
10
8
6
4
2
0
1 wk 1 month 6 month
dropped 2 lines
no imp
gained 1-2 lines
gained 3-4 lines
gained 5 lines
Change in spherical equivalent
Median Max Min
preoperative -6.25 -12.00 -2
1 week -1.80 -6.00 -0.50
1 month -2.01 -4.50 plano
6 month -2.29 -6 plano
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11/18/2012
change in spherical equivalent
6 month
1 month
1 wk
change in sphericl
equivelant
preop
-8 -6 -4 -2 0
Change in average K
Median Max Min
preoperative 48.9 D 56.00 D 45.40 D
1 week 45.00 D 49.00 D 41.00 D
1 month 45.80 D 49.50 D 41.00 D
6 month 46.00 D 50.00 D 41.50 D
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50
49
48
change in average K
47
46
change in average K
45
44
43
preop 1 wk 1 month 6 month
Change in K max
Median Max Min
preop 54.8 61.6 48.1
1 wk 50.7 56.9 46.5
1 month 50.8 56.8 46.3
6 month 50.9 56.9 46.2
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56
55
54
53
52
51
50
49
48
change in K max
change in K max
preop
6 month
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complications
• Operative :
-Epith defect
-Incomplete tunnel :1 eye
-Subconj hege.
-No perforation
• Postoperative:
-Migration & extrusion : 1 eye
-White deposits : 3 eyes
conclusion
• Safe
• Effective
• Improving VA (gls , soft CL)
• Reduce refractive errors
• Delay or eliminate the need for PKP
• Reversible
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11/18/2012
conclusion
•Femto second Vs manual :
• Better centration
• Better depth
• Better location
• Safe : no perforation
15