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Flap versus pocket-based procedures for corneal inlay implantation

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Session Details

Session Title: Presbyopic Corrections

Session Date/Time: Monday 15/09/2014 | 16:30-18:30

Paper Time: 17:10

Venue: Boulevard F (Level 1)

First Author: : D.Kent NEW ZEALAND

Co Author(s): :                  

Abstract Details


To evaluate and compare the visual performance and outcome stability for patients implanted with a small aperture intra-corneal inlay under a flap versus in a lamellar pocket.


Fendalton Eye Clinic, Christchurch, New Zealand


Retrospective comparative analysis of 6-month data from 123 patients implanted monocularly with a KAMRA inlay (AcuFocus, Irvine, CA) using either a flap- (N=93) or pocket-based (N=30) procedure. In the flap-based procedure the inlay was implanted under a 200-micron femtosecond laser flap immediately following a LASIK treatment. In the pocket-based procedures the inlay was implanted into a 200-250 micron femtosecond laser-created lamellar pocket either as a standalone procedure or with LASIK using a dual-interface technique. The manifest spherical equivalent refraction (MRSE), uncorrected near acuity (UNVA), uncorrected distance acuity (UDVA), best-corrected distance acuity (BDVA) were evaluated pre-operatively and at 1, 3 and 6-months post-operatively. Distance visual acuity is represented in Snellen and near vision in Jaeger notation. Refractive stability and safety defined by loss of 2 or more lines of pre-operative BDVA are reported.


In flap patients, UDVA changed from 20/30 pre-operatively to 20/32 at 6-months (p = 0.51). In pocket patients, UDVA improved by a line from 20/40 pre-operatively to 20/30 at 6-months (p = 0.79). In flap patients, UNVA improved from J7 pre-operatively to J1 at 6-months (p <0.0001). In pocket patients, UNVA improved from J4 pre-operatively to J1 at 6-months (p = 0.01). At 6-months average MRSE was -1.23 D ± 0.60D in flap and -0.77D ± 0.67D in pocket patients respectively. At 6-months 8% of flap patients lost 2 or more lines of BDVA versus none of the pocket patients. 95% of flap and 100% of pocket patients had BDVA of 20/25 or better at 6-months respectively. 13.5% of flap patients experienced a hyperopic refractive shift of +1.00D or more at 6-months; none of the pocket patients experienced +1.00D or more shift over the same follow-up timeframe.


Both flap- and pocket-based procedures provide similar significant improvements to near vision with minimal to no compromise to distance vision. However, the pocket-based procedures provide improved safety and refractive stability results over the 6-month period.

Financial Interest:

One or more of the authors... receives nonNONEmonetary benefits from a company producing, developing or supplying the product or procedure presented., One or more of the authors... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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