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Session Title: Refractive
Session Date/Time: Sunday 16/02/2014 | 08:30-11:00
Paper Time: 08:48
Venue: Kosovel Hall (Level -2)
First Author: : ErikaEskina RUSSIA
Co Author(s): : Pavel Rybakoff Viktoria Parshina
To evaluate the postoperative clinical outcomes in terms of binocular and monocular uncorrected visual acuities and visual quality among presbyopic patients that have underwent standard PRK treatments.
Prof. Erika N. Eskina, MD, Laser surgery clinic SPHERE, Moscow, Russia
14 presbyopic patients (28 eyes) (48±5 years, range 41 to 59) with distance refraction SEQ -6.25D to +4.25D and astigmatism up to 1.75D with presbyopic add 1.75D to 2.25D were analysed – six myopic patients and eight hyperopic patients. PresbyMAX µ-monovision bi-aspheric treatments were planned with Custom Ablation Manager software and ablations performed using the SCHWIND AMARIS flying-spot excimer laser system (both SCHWIND eye-tech-solutions). PRK with use of Mitomycin C post laser ablation has been carried out in all cases. Standard examinations, a preoperative multifocal soft contact lens trial, pre- and postoperative wavefront analysis as well as preoperative pupillometry (both SCHWIND SIRIUS) in different standardised light conditions, and contrast sensitivity testing (Astroinform ZEBRA N 3) were performed. Clinical results were evaluated in terms of refractive outcome, visual acuity, and contrast sensitivity. Clinical outcomes of six months follow-up were analyzed.
The myopic group (6 patients) showed spherical equivalent power of -0.42±0.34 in distance eye (DE) and -1.17±0.38 in near eye (NE). Residual cylinder refraction was -0.17±0.24 in DE and -0.42±0.31 in NE. Uncorrected distance visual acuity (UDVA) was 0.07±0.09 logMAR in DE and 0.25±0.12 logMAR in NE. 100% achieved 0.0 logMAR binocular uncorrected distance visual acuity (CDVA) and 0.1 logRAD or better binocular corrected near visual acuity (CNVA). Uncorrected near visual acuity (UNVA) demonstrated 0.14±0.07 logRAD in DE and 0.07±0.05 logRAD in NE. The hyperopic group (8 patients) showed spherical equivalent power of -0.59±0.59 in DE and -1.41±0.75 in NE. Residual cylinder refraction was -0.11±0.12 in DE and -0.25±0.30 in NE. UDVA was 0.15±0.18 logMAR in DE and 0.29±0.20 logMAR in NE. 100% achieved 0.1 logMAR CDVA or better and 0.2 logRAD or better CNVA. UNVA demonstrated 0.22±0.13 logRAD in DE and 0.12±0.06 logRAD in NE. In both groups, the targeted anisometropia of 0.75D (µ-monovision approach) between DE and NE was achieved. In both groups, contrast sensitivity (black-white) showed minor changes only compared to preoperative levels and normal diapason, with less negative effect on higher spatial frequencies. Black-red contrast values were even better than preoperative.
The PresbyMAX µ-monovision approach using multifocal bi-aspheric ablation profiles provides spectacle independence and high distance and near vision acuity for our patients. Target anisometropia of 0.75D between DE and NE was achieved exactly. Near visual acuity increases fast (from one week to one month) when performing PresbyMAX presbyopia correction in combination with standard PRK method. Distance visual acuity recovers more slowly and took up to 3 months in the presbyopic myopic group. Recovery (for distance) in the presbyopic hyperopic group is even longer and took up to 6 months. In future, a slight refractive increase of -0.25D from manifest value in the myopic group and a reduction of +0.50D from cycloplegic value in hyperopic group is advised looking at the 6 months follow-up. Presbyopia correction requires a careful examination before operation, with use of strict exclusion criteria and detailed explanation about visual recovery to the patient. Further study and longer follow-up period have to show the safety and effectiveness of corneal presbyopia correction with use of surface ablation technique. FINANCIAL INTEREST: NONE