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First Author: M.Ziaei UK
Co Author(s): A. Mearza
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A variety of surgical techniques including corneal and intraocular lens (IOL) procedures have been utilized in recent years to correct presbyopia. In this interventional case report we describe the surgical correction of a 32 year old pseudophakic patient with the KAMRA (Acufocus, Inc) corneal inlay. To the best of our knowledge this is the youngest patient in the world to undergo such a procedure.
Focus Laser Vision, London, United Kingdom.
The procedure was performed under local anaesthetic eye drops. A 200 micron corneal flap was made with a femtosecond laser (Zeimer Ophthalmic systems, Switzerland). An excimer laser (Wavelight Allegretto 400 Hz, Alcon) was then used to correct the patients refractive error aiming for a post-operative target of -0.50 dioptres. The KAMRA inlay was then placed aligned with the coaxially sighted corneal reflex first (Purkinje I) intraoperatively. The LASIK flap was then reflected back to its original position and the gutter dried. Antibiotic and steroid drops were then applied and the patient was asked to continue these post-operatively along with regular lubricants. The postoperative period was uneventful.
At the 1 month post operative time gate, uncorrected distance visual acuity (UCDA) was 6/6 and uncorrected near visual acuity (UCNA) was J5 in the right eye and at the 6 month time gate, UCDA had improved further to 6/5 and UCNA had improved to J3 in the right eye. The eye was quiet and comfortable with an unremarkable postoperative period.
The KAMRA corneal inlay offers unique advantages in that it is reversible, relatively easy to reposition, and can be combined with other refractive procedures. It also offers other advantages over multifocal corneal ablation or IOL implantation in that it does not significantly impact contrast sensitivity and does not require neuroadaptation to multifocality. The procedure also boasts a lower regression rate when compared to multifocal Laser in situ keratomileusis (LASIK) or monovision LASIK. The KAMRA inlay also does not require power calculation and is not an intraocular procedure with its associated complications which are distinct advantages when compared to piggyback lenses such as the sulcoflex multifocal IOL (Rayner inc). In our patient, the KAMRA inlay was the safest least invasive option to restore near vision without compromising distance acuity in the affected eye. This case illustrates the successful and unique use of the KAMRA inlay in a young unilateral pseudophakic patient and adds to our armamentarium in terms of refractive techniques we can offer.