Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan

2006年10月28日中2006年10月28日中國廈門屈光手術研討會國廈門屈光手術研討會

Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan

台灣諾貝爾醫療集團張朝凱醫師 .陳美齡醫師 .王倫奕醫師 .劉淳熙醫

師 .張鼎業醫師 .林玉凰醫師 .戴文瑛醫師 .蕭清仁博

士


Surface AblationSurface Ablation

This year( 2006 ) we went This year( 2006 ) we went

B to BB to BBack to Bowman’sBack to Bowman’s


Back to Bowman’sBack to Bowman’s

There has been a There has been a significant movement backsignificant movement back to surface ablation.to surface ablation.

Major recent improvements in surface Major recent improvements in surface ablation include ablation include gradual blend zonesgradual blend zones and and

Mitomycin C for haze.Mitomycin C for haze.



Concerns for Lamellar AblationConcerns for Lamellar Ablation– Deeper ablationsDeeper ablations due to larger ablation due to larger ablation

zoneszones– Increased concern of Increased concern of ectasiaectasia– Improved visual results?Improved visual results?

No flap related aberrationsNo flap related aberrations

Bowman’s membrane a more regular canvas Bowman’s membrane a more regular canvas than stromathan stroma



IndicationsIndications– Thin corneas Thin corneas – Patients predisposed to ocular traumaPatients predisposed to ocular trauma– Detachment surgeryDetachment surgery– GlaucomaGlaucoma– Flat corneasFlat corneas– Steep corneasSteep corneas– Deep-set eyesDeep-set eyes



Relative to Lamellar ablationRelative to Lamellar ablation– No flap related complicationsNo flap related complications

No striaeNo striae

Less dry eyeLess dry eye

No irregular flapsNo irregular flaps

No DLKNo DLK


PurposePurpose

To evaluate initial clinical outcome To evaluate initial clinical outcome with Epi-LASIK for myopia with with Epi-LASIK for myopia with astigmatismastigmatism


MethodsMethods

Three months results from a cohort of 56 Three months results from a cohort of 56

eyes ( 30 patients ) that had eyes ( 30 patients ) that had Epi-LASIK Epi-LASIK

proceduresprocedures with and without Flap Removal

as well as PRK were studied .All were studied .All

operations were done with Amadeus 2 operations were done with Amadeus 2

( AMO, Santa Ana ,CA , USA ). ( AMO, Santa Ana ,CA , USA ).


MethodsMethodsFor Epi-LASIK,epithelial separation was achieved For Epi-LASIK,epithelial separation was achieved

mechanically without the use of alcohol.mechanically without the use of alcohol.

The epithelial flap was remained (Option1) or removed The epithelial flap was remained (Option1) or removed

(Option 2) and a therapeutic contact lens was applied to (Option 2) and a therapeutic contact lens was applied to

the cornea immediately for 3 to 5 days.the cornea immediately for 3 to 5 days.

PRK patients were as usualPRK patients were as usual

Postoperative Postoperative epithelial defect sizeepithelial defect size , , symptomssymptoms, , UCVA, UCVA,

BCVABCVA were evaluated at three months postoperatively. were evaluated at three months postoperatively.


MethodsMethods

Surgical ParametersSurgical Parameters

– Oscillation speed: 11,000 rpmOscillation speed: 11,000 rpm

– Translation speed: 1.5 mm/secTranslation speed: 1.5 mm/sec

– Suction: 22 mm HgSuction: 22 mm Hg

– Epithelial removal 9.0 mmEpithelial removal 9.0 mm


Epi-LASIKEpi-LASIK


What is Surface Ablation (Epi What is Surface Ablation (Epi Lasik) ?Lasik) ?Compare pig eye and human eyeCompare pig eye and human eye


Option 1 (Flap Remain)Option 1 (Flap Remain)


Option 2 (Flap Removal)Option 2 (Flap Removal)


MethodsMethods

Epithelial defect sizeEpithelial defect size was measured with the slit lamp and was measured with the slit lamp and

recorded with recorded with digital photographydigital photography daily until epithelial daily until epithelial

defects healeddefects healed

Post-operative Post-operative symptoms , UCVA, BCVAsymptoms , UCVA, BCVA were studied were studied

All patients received postoperative 0.1 FML qid for 3 weeks, All patients received postoperative 0.1 FML qid for 3 weeks,

Ciloxan qid for 1 week,, and BSS qid for over 6 weeksCiloxan qid for 1 week,, and BSS qid for over 6 weeks

Bandage contact lenses were removed after 4 days and Bandage contact lenses were removed after 4 days and

corneas were stained with fluoresceincorneas were stained with fluorescein


ResultsResults

1.1.Epithelial Defect SizeEpithelial Defect Size2.2.Postoperative symptomsPostoperative symptoms3.3.UCVAUCVA4.4.BCVA BCVA

1.1.Epithelial Defect SizeEpithelial Defect Size2.2.Postoperative symptomsPostoperative symptoms3.3.UCVAUCVA4.4.BCVA BCVA


1.Epithelial Defect Size (mm) Following Epi-LASIK, with and

without Flap Removal, and PRK

0

1

2

3

4

5

6

7

8

9

10

Day 1 Day 3 Day 5

Flap Remain

Flap Removal

PRK


Patient 1(Epi - LASIK)Patient 1(Epi - LASIK)

手術後第 1天手術後第 1天





Patient 2 (PRK)Patient 2 (PRK)






Fluorescing StainFluorescing Stain

Flap removal 24 hours Flap removal 48 hours Flap removal 72 hours

PRK 24 hours PRK 48 hours PRK 72 hours


2.Pain Following Epi-LASIK, with and without Flap Removal, and

PRK

0

1

2

3

4

5

6

7

8

9

10

Day 1 Day 3 Day 7

Flap Remain

Flap Removal

PRK

Pain significantly greater with PRK on day 1 and 3Pain significantly greater with PRK on day 1 and 3


3.UCVA Following Epi-LASIK, with and without Flap Removal,

and PRK

15

25

35

45

55

65

Day 3 Day 7 Month 1

Flap Remain

Flap Removal

PRK

UCVA significantly better with flap removal on day 3 and 7UCVA significantly better with flap removal on day 3 and 7


4.BCVA Following Epi-LASIK, with and without Flap Removal,

and PRK

15

25

35

45

55

65

Day 3 Day 7 Month 1

Flap Remain

Flap Removal

PRK

BCVA significantly better with flap removal on day 3 and 7BCVA significantly better with flap removal on day 3 and 7


What are the advantages of What are the advantages of Surface Ablation compared with Lasik?Surface Ablation compared with Lasik?

• He can do higher correction on thin cornea.

• No stroma is leaving on the flap.

• No cut through the stroma

• Less risk by doing the flap

Discussion 1Discussion 1


Why is Surface Ablation not always used?Why is Surface Ablation not always used?

• In average patients have more pain during the first 5 days post OP.

• It is a little more difficult to handle a Surface Ablation flap than a Lasik Flap.

Surface Ablation does not substitute the Lasik:

• Surface Ablation is a complementary method to Lasik.

• Because of the wider range of possible patients, Doctor can operate about 12-17% more patients if he can use both systems.




The most important initial event following The most important initial event following

surface ablation is for the corneal epithelium to surface ablation is for the corneal epithelium to

heal as rapidly as possible as the outcome of heal as rapidly as possible as the outcome of

surface ablation is closely related to the surface ablation is closely related to the

epithelial wound healing response.epithelial wound healing response.11 11Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg 2000. Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg 2000.



Delayed re-epithelialization increasesDelayed re-epithelialization increases

– Time for visual rehabilitationTime for visual rehabilitation

– Incidence of postoperative hazeIncidence of postoperative haze

– Pain and photophobiaPain and photophobia

– Risk of infectious keratitisRisk of infectious keratitis11Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg 2000.2000.

11Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg 2000.2000.



Epi –LASIK -Mechanical separation without alcohol Epi –LASIK -Mechanical separation without alcohol preserves the integrity of the epithelium and preserves the integrity of the epithelium and stroma.stroma.

Partners well with wavefront-guided custom Partners well with wavefront-guided custom ablation.ablation.

This may allow for improved:This may allow for improved:ComfortComfortPredictabilityPredictabilityVisual recovery.Visual recovery.


Conclusion 1Conclusion 1

Epi-LASIK with the Amadeus II Epi-LASIK with the Amadeus II

microkeratome removes the entire microkeratome removes the entire

corneal epithelial layer with no corneal epithelial layer with no

discernible damage to the removed discernible damage to the removed

tissue or damage to Bowman’s tissue or damage to Bowman’s

membrane. membrane.



Epi-LASIK (with Epi-LASIK (with flap remainflap remain) with the ) with the

Amadeus II microkeratome provides Amadeus II microkeratome provides

greater greater patient comfortpatient comfort than PRK or Epi- than PRK or Epi-

LASIK (with flap removal) during the LASIK (with flap removal) during the

immediate post-operative periodimmediate post-operative period



Epi-LASIK (with Epi-LASIK (with flap removalflap removal) with the ) with the

Amadeus II microkeratome provides Amadeus II microkeratome provides

more more rapid visual rehabilitationrapid visual rehabilitation than than

PRK or Epi-LASIK (with PRK or Epi-LASIK (with flap remainflap remain) )

during the immediate post-operative during the immediate post-operative

periodperiod



We need long term studies to evaluate We need long term studies to evaluate

the efficacy of Epi-LASIK looking atthe efficacy of Epi-LASIK looking at

– BCVA/UCVABCVA/UCVA

– Corneal HazeCorneal Haze

– Corneal Sensitivity and Tear FunctionCorneal Sensitivity and Tear Function (AJO (AJO

Volime 142 , issue 4 , Oct 2006) Volime 142 , issue 4 , Oct 2006)

– Quality of vision and high order aberrationsQuality of vision and high order aberrations


CONCLUSIONCONCLUSION

Epilasik for Epilasik for moderate to high moderate to high myopia with the myopia with the Amadeus II Amadeus II Epikeratome Epikeratome – SafeSafe– ReproducibleReproducible– Good patient Good patient

satisfaction satisfaction

Thank youThank you

Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan

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