International Vision Correction Research Centre mike holzermed uniheidelberg

International Vision Correction Research Centre mike. holzer@med. uni-heidelberg. de www. lasik-hd. de Corneal changes following INTRACOR femtosecond laser treatment Mike P. Holzer, MD Annett Mannsfeld, MSc Angela Ehmer, MSc Gerd U. Auffarth, MD Dept. of Ophthalmology, University of Heidelberg, Germany Acting chairman: G. U. Auffarth, MD Study and research has been supported by Technolas Perfect Vision Gmb. H, Heidelberg, Germany

Femtosecond Laser: Femtec (Technolas Perfect Vision Gmb. H, Heidelberg, Germany) ü CE mark ü FDA 510 k clearance ü 40 k. Hz FEMTEC fixation of eye: Curved patient interface less stress on cornea less suction pressure Mike P. Holzer, MD

INTRACOR • Purely intrastromal refractive treatment with Femtec Laser • No cut of epithelium, Bowman‘s or Descemet • No incision, pockets etc. • Cut design and stromal depth algorithm depending on refractive error • Duration approx. 20 seconds Mike P. Holzer, MD

Patients & Methods • Ongoing prospective, multicenter study • Approval of Ethics Committee (Univ. of Heidelberg) • Intrastromal correction of presbyopia • 25 patients treated between July & Sept. 2008 • Age 56. 2 ± 5. 79 years (range 47 – 67 years) • Up to 6 months postoperative follow up • Minimum near add +2. 0 D • Non dominant eye treated Mike P. Holzer, MD

INTRACOR Presbyopia Cavitation gas in ring cuts 4 days preop Mike P. Holzer, MD 1 hour postop Gas escaped from cornea 1 day postop 1 week postop

Development near UCVA UCNVA pre 0 0. 1 n=25 UCNVA 1 DUCNVA 1 W n=25 UCNVA 1 M n=25 UCNVA 3 M n=24 Visual acuity in log. MAR 0. 2 0. 3 0. 4 * 0. 5 0. 6 * p < 0. 01 0. 7 Friedman-Test 0. 8 0. 9 1 0. 7 = 20/100 Mike P. Holzer, MD 0. 26 = 20/30 DCNVA: 0. 23 ± 0. 08 log. MAR

Development near UCVA preop 3 M postop Mike P. Holzer, MD

Near and distance visual acuity Distance correction preop 3 M postop Sphere +0. 75 D ± 0. 23 D +0. 15 ± 0. 31 D Cylinder -0. 33 D ± 0. 17 D -0. 42 ± 0. 23 D preop D 1 W 1 M 3 UCDVA 0. 11 ± 0. 11 0. 09 ± 0. 10 0. 06 ± 0. 08 0. 06 ± 0. 09 0. 05 ± 0. 10 BCDVA -0. 06 ± 0. 06 na na -0. 02 ± 0. 06 0. 00 ± 0. 07 UCNVA 0. 70 ± 0. 16 0. 39 ± 0. 25 0. 39 ± 0. 22 0. 36 ± 0. 18 0. 26 ± 0. 21 DCNVA 0. 59 ± 0. 12 na na 0. 33 ± 0. 17 0. 23 ± 0. 18 BCNVA -0. 04 ± 0. 08 na na 0. 01 ± 0. 10 -0. 03 ± 0. 07 Mike P. Holzer, MD

Pentacam pre- / 3 M postop: Exp. 1 Mike P. Holzer, MD Preop 3 M postop central steepening

Pentacam pre- / 3 M postop: Exp. 2 Mike P. Holzer, MD Preop 3 M postop central steepening

Corneal asphericity Q-value (6. 0 mm) pre anterior pre posterior 1 M anterior 1 M posterior 3 M anterior 3 M posterior Mean value -0. 20 -0. 34 -0. 25 -0. 43 -0. 26 -0. 41 Std. Dev. 0. 16 0. 18 Q-value more negative following INTRACOR treatment Mike P. Holzer, MD

Summary: INTRACOR • High potential for correction of presbyopia • Non invasive very low risk for infections • Stable refractive outcome during follow up period • Significant gain in uncorrected near visual acuity • Slight central steepening and negative q-value • No weakening of cornea • Future treatments: low myopia / hyperopia / astigmatism, retreatments of remaining refractive errors following IOL- or Excimer Laser Surgery Mike P. Holzer, MD