Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD,...

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Segment Implantation to the Tunnel Created by the Femtosecond Laser: Evaluation of One Year Results Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova , MD Kristina Hakucova, MD Department of Ophthalmology of the First Faculty of Medicine of Charles University and Central Military Hospital, Prague None of the authors has a financial interest on the presented data.

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Transcript of Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD,...

Page 1: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Segment Implantation to the Tunnel Created by the

Femtosecond Laser: Evaluation of One Year Results

Authors: Jaroslav Madunicky, MD

Katerina Buusova Smeckova, MD, MBACol. Assoc.Prof. Jiri Pasta, MD, PhD.

Iveta Nemcova, MD, PhD.Eva Vyplasilova , MD

Kristina Hakucova, MD

Department of Ophthalmology of the First Faculty of Medicine of Charles University and Central Military Hospital, Prague

None of the authors has a financial interest on the presented data.

Page 2: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Purpose• To evaluate the change of change in the

refractive error, BCVA, pachymetry and corneal topography of 50 patients, who underwent in our Clinic since 2009 uni- or bilateral implantation of the keraring(s) using the femtosecond laser iFS 150 following Madunicky Formula.

• To statistically evaluate effect based on the degree of keratoconus (I-IV) and max. keratometry localization.

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Page 3: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Setting / VenueN° of patients

Total Male Female50 44 6

N°of eyes 53Mean age 33 (20 ; 55)Preop UCVA 0,26(0,05 ; 0,5)Preop BCVA 0,63(0,2 ; 1,0)Preop refractive error -1,35()-3,76 [0.00()-1,25; -4,5()-6,25]Preop autorefractometry -4,57()-5,78 [-10,75;+2,50 () -1;-9,75]]Pachymetry 459,52 [426 ; 500]Max. keratometry 58,21 [48,1 ; 66,7]Degree of keratoconus according to Pentacam

1-2 2 3 3-40,5% 9,5% 10% 80%

Type of ectasia1 2 3 4

13% 41% 28% 18%

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Page 4: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

MethodsProspective, unmasked, non-randomized study of 50

patients with keratoconus (53 eyes), grade 2 to 3-4, who underwent the implantation of SI-5 Keraring/s.

Degree of keratoconus and type of ectasia according to the localization of maximal keratometric readings were determined, other pathologies were described.

Preoperatively and 1, 6 and 12 months postoperatively UCVA, BCVA, autorefractometry, pachymetry measurements and keratometry readings were obtained.

Implantation of keraring/s was performed in local anesthesia implanted into the tunnel created by Intralase iFS 150 set according to the Madunicky Formula. No peroperative complications were reported.

Ring was selected according to the currently valid nomogram and preoperative examination of the patient.

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Page 5: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

MADUNICKY´S FORMULADF = (0.8 TP x AC) - (SC x RC)

DF = (0.8 TP x 0.92) - (-20 x 0.5/0.1)

DF: Depth of the femtotunnel (µm)TP: Thinnest pachymetry (µm)

AP: Applanation coefficientSC: Safety coefficient (µm)

RC: Ring coefficient

Page 6: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Results I.Mean UCVA-1M,6M and 12 M after implantation

UCVA 12 Months after Procedure

6

11%

11%

78%

Worse Unchanged Improvedprior

surgery1M

postop6M

postop12M

postop

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

0.26

0.34

0.440.46

Page 7: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Results II: Evaluation of UCVA & BCVA

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before surger

y

1M after

6M after

12M after

•-1,3Dsf/-2,2Dcyl=0,62

• 0,41 +/- 0,07 [0,2;0,9]

• -2,50Dsf/-2,4Dcyl=0,63

• 0,44 +/- 0,05 [0,2;0,8]

• -1,81Dsf/-1,82Dcyl=0,63

• 0,34 +/- 0,03 [0,1;0,7]

• 0,25 +/- 0,02 [0,05;0,5]

• -1,34Dsf/-3,76Dcyl=0,63

Improved by 1,61D of SE

Page 8: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Results III.Change in pachymetry Change in K max. and

grade

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Prior 1M after 6M after 12M af-ter

Pachymetry

459.52380952381

469.142857142857

471.4 470.777777777778

453455457459461463465467469471

μm

0.010.020.030.040.050.060.0

58.2

2.9

50.9

2.6

Prior surgery12M after

KmaxDegree of

keratoconus

Prior surgery 58,2 [48,1 ; 66,7] 2,9 [1,5 ; 3,5]

12M after 50,9 [44,8 ; 52,8] 2,6 [1 ; 3,5]

Page 9: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Results IV.: Evaluation of Autorefractometry & Pachymetry

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before surger

y

1M after

6M after

12M after

•477,77[453;529] um

• -2,39Dsf/-2,17Dcyl

• 471,14[438;527] um

• -3,45Dsf/-2,75Dcyl

• 469,14[423;583] um

• -2,42Dsf/-2,87Dcyl

• -4,57Dsf/-5,78Dcyl

• 459,52 [426;500] um

Improved by 5,79 D of SE Improved by 18,25 [3;31]

Page 10: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Results V. In the interval of 1 year of the implantation 2/3 of

patients have improved both their UCVA and BCVA. Statistically are the most succesfull group grade II and III. In this group there is no worsening of the BCVA, in 1/3 it only remained unchanged. Vision of 11% of patients in the group grade III-IV got worse during this period.

In a group grade II-III is more expressive the change of the SE, as the flattening of the extasia.

Ring dislocationOptical phenomenon

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Complications

Page 11: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

Comparison of possible keratoconus treatments

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Page 12: Authors: Jaroslav Madunicky, MD Katerina Buusova Smeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova, MD Kristina.

ConclusionKeraring implantation with the iFS 150 following

Madunicky Formula and up-to-date nomograms, when performed by an experienced surgeon, seems to be a safe and full-valued treatment, which helps patients on their way to stabilize the disease and to postpone the need to perform a perforative keratoplasty.

The effect of implantation is quite individual and it depends on the degree of disease, progression / stability of the disease and the location of the ectasia in the cornea (depth, symetry).

On our clinic we perform the implantation of the intrastromal segments only with the femtosecond laser set according to the Madunicky Formula. The results seem to be very perspective. The procedure itself is less stressful for both patient and surgeon and we have not reported so far any case of extrusion or perforation.

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