Femtosecond laser assisted intrastromal corneal ring segment implantation

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Femtosecond laser assisted intrastromal corneal ring segment implantation for post-lasik corneal ectasia Dominique PIETRINI,

Femtosecond laser assisted intrastromal corneal ring segment implantation for post-lasik corneal ectasia Dominique PIETRINI, MD Tony GUEDJ, OD, ORTH Clinique de la Vision, Paris. dpietrini@club. fr Financial disclosure: Dr D. Pietrini is a paid consultant for Mediphacos Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Materials and Methods • 13 eyes with post lasik ectasia, follow up 6 months

Materials and Methods • 13 eyes with post lasik ectasia, follow up 6 months to 4 years. • Mean age 38 years • Initial surgery – Microkeratome 80% Femtosecond 20% – Time between lasik ands ICRS 3 years – Form frust keratoconus in 8 cases / Insufficient stromal bed 2 cases / unkown etiology or association remaining cases • ICRS femtosecond implantation all cases • 3 eyes implanted with Intacs (Addition technology) • 10 eyes implanted with Kerarings (Mediphacos) • Interest of OCT for corneal evaluation • Mean flap thickness 148µm +/- 16. 5µm (120/200) • Mean residual stromal bed 294µm +/- 55. 1µm (210/400) Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Evolution of spherical equivalent and refractive cylinder N=13 Dominique PIETRINI / Tony GUEDJ (Paris)

Evolution of spherical equivalent and refractive cylinder N=13 Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Evolution of uncorrected and best corrected visual acuity UCVA Mean gain 5 lines BCVA

Evolution of uncorrected and best corrected visual acuity UCVA Mean gain 5 lines BCVA Mean gain 3 lines p<0. 05 N=13 Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Keratometric measurements Orbscan readings Keratometry Mean K reduced by 3 D Kmax reduced by

Keratometric measurements Orbscan readings Keratometry Mean K reduced by 3 D Kmax reduced by 4. 6 D p<0. 05 N=13 Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Corneal astigmatism N=13 Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR

Corneal astigmatism N=13 Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

High Order Aberration HOA Rms showed a reduction of 59% after 2 years for

High Order Aberration HOA Rms showed a reduction of 59% after 2 years for Two eyes Vertical Coma showed a reduction of 69% after 2 years for Two Eyes H. Coma N=2 Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Case Report M. A. B, Man, 33 years old Post lasik ectasia: Marginal pellucid

Case Report M. A. B, Man, 33 years old Post lasik ectasia: Marginal pellucid corneal dystrophy KERATOMETRY: LEFT EYE PRE OP 1 Week after KERARING IMPLANTATION 38. 4 D /43. 7 D 3° 38. 2 D/40. 9 D 175° ASTIGMATISM: 5. 3 D 2. 7 D PACHYMETRY: 401µm 414µm UCVA: 0. 5 Log mar (3/10) 0. 0 Log mar (9/10) BCVA: 0. 0 Log mar (10/10 F) -0. 1 Log mar (12/10) REFRACTION: +1, 75 (-4, 50)85° +2. 50 (-2. 50)85° Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

OCT Visante Corneal Flap OCT PRE OP : Size of corneal flap Post lasik

OCT Visante Corneal Flap OCT PRE OP : Size of corneal flap Post lasik ectasia on marginal pellucid corneal dystrophy Corneal Flap KERARING OCT POST OP KERARING: Depth: 310µm Corneal Flap: 120µm Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Orbscan Dual Corneal Flap POST LASIK ECTASIA : Marginal pellucid corneal dystrophy OCT PRE

Orbscan Dual Corneal Flap POST LASIK ECTASIA : Marginal pellucid corneal dystrophy OCT PRE OP POST LASIK ECTASIA PRE OP Corneal Flap REFRACTION: +1, 75 (-4, 50)85° UCVA: 0. 5 Log mar BCVA: 0. 0 Log mar POST OP 1 Week KERARING REFRACTION: +2. 50 (-2. 50)85° UCVA : 0. 0 Log mar BCVA: -0. 1 Log mar OCT POST OP POST LASIK ECTASIA POST KERARING DEPTH: 330µm Corneal Flap: 120µm Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

CONCLUSION • Femtosecond intrastromal corneal ring segment implantation is an affective and safe method

CONCLUSION • Femtosecond intrastromal corneal ring segment implantation is an affective and safe method for the management of post lasik ectasia. • Restores good level of visual acuity. • Objective improvement of visual acuity. – – BCVA improved by 3 lines. Corneal astigmatism reduced by 2, 6 d. Maximal keratometry reduced by 4. 6 diopters. Reduce Hoa Rms. • High patient satisfaction. • Low complications rate. • Reversible. Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Dominique Pietrini, MD, is a member of the active staff of the Clinique de

Dominique Pietrini, MD, is a member of the active staff of the Clinique de la Vision, Paris France. Dr. Dominique Pietrini states that he is a paid consultant to Mediphacos. Dr. Pietrini can be reached at +33 145 630 668 dpietrini@club. fr www. cliniquevsion. com Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA

Tony Guedj, OD, ORT Clinique de la vision, Paris France. Tony Guedj can be

Tony Guedj, OD, ORT Clinique de la vision, Paris France. Tony Guedj can be reached at +33 145 630 668 tony. guedj@yahoo. fr Dominique PIETRINI / Tony GUEDJ (Paris) INTRASTROMAL CORNEAL RING SEGMENT FOR POST LASIK ECTASIA