First Author: F.Sanchez Leon MEXICO
Co Author(s): S. Sanoja Sarabia E. Angel Mu E. T. Brooker
Purpose:
To assess whether a corneal pocket can be created safely under a previous LASIK flap as a prelude to implantation of a small aperture corneal inlay for treatment of presbyopia in patients with prior LASIK distance vision correction.
Setting:
Novavision Laser Center, Mexico City
Methods:
A corneal inlay (KAMRA Inlay, AcuFocus, Inc.) was inserted into a corneal pocket in patients with previous LASIK. Criteria: 45-60 years, UCDVA 20 /20 or better untreated eye, near UCDVA of 20/50 or J4 on treatment eye, SE -0.75 to 0, ? 0.75 D cylinder, and prior flap thickness ? 160 µ with corneal thickness > 480 µ and normal corneal topography. Pockets were created in the non-dominant eye with a femtosecond laser. Pockets 6.5 mm wide opened temporally and were positioned to leave 250 µ of residual posterior stroma. Measures included corneal thickness via ultrasound pachymetry (Sonogage, Inc) and Fourier domain OCT (FD-OCT, Optovue, Inc) and flap thickness using FD-OCT.
Results:
LASIK to corneal inlay time 93.42 m. (7 y and 7 m) Range 42 to 113 m. Pocket procedure was performed on 7 patients, 5 male/2 female. UCNVA improved 5 lines from J6 at preop to J1, and mean UCDVA was 20/25 versus 20/20 due to a slight myopic shift, at 12 m. Mean central corneal thickness showed good correlation between pachymetry (524.7 ± 33.2 µ) and FD-OCT (526.6 ± 17.3 µ). Original LASIK flap thickness was targeted 90 µ one patient and 160 µ in 6 patients (mean 150 µ). The FD-OCT mean LASIK flap thickness before pocket procedure 138.4 µ. Mean distance between flap and pocket was 138.1 µ. FD OCT showed a mean of 256 µ for Corneal Inlay depth achievement (attempted 250 µ). Cornea or flap structure showed no damage.
Conclusions:
To date, the creation of a pocket flap beneath a LASIK flap has resulted in a significant improvement in near vision and no associated safety issues were observed clinically and at the FD OCT. Such procedure may allow the use of a small aperture corneal inlay to treat presbyopia in patients with previous LASIK to improve Near UCVA. FINANCIAL DISCLOSURE?: ... is employed by a forNoprofit company with an interest in the subject of the presentation, ... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented
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