dr. coşkunseven "combination of keraring and toric phakic implantable collamer lens for...
Post on 03-Jul-2015
105 Views
Preview:
DESCRIPTION
TRANSCRIPT
COMBINATION OF KERARING AND TORIC
PHAKIC IMPLANTABLE COLLAMER
LENS FOR KERATOCONUS
Efekan Coskunseven, MDDünya Göz / World Eye Hospital, Istanbul, Turkey
Keraring User Meeting
ESCRS LONDON
2014.
COMBINED TREATMENT OPTIONS
+
+
+ +
0.63
0.82
0.87 0.88 0.89 0.89
0.3
0.4
0.79
0.830.85
0.88
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Pre corsslinking Pre ICL After 7 days After 1month After 3months After 6months After 1year
BSCVA UCVA
BSCVA & UCVA
0.56
0.88
METHODS
+
Stop Progression
<1,5D IrregularitySph<-18 D
Cyl<5 D
COMBINED TREATMENT OPTIONS
+
+
+ +
TORIC ICL IMPLANTATION AFTER
INTRACORNEAL RING IMPLANTATION FOLLOWED
BY CORNEAL COLLAGEN CROSSLINKING FOR
THE TREATMENT OF KERATOCONUS
+ +
J Cataract Refract Surg. 2013 Mar 13. doi:pii: S0886-
3350(13)00003-5. 10.1016/j.jcrs.2012.11.027
METHODS 14 eyes of 9 patients with keratoconus
ICLToric implantation after Intracorneal Ring Segment Implantation
followed by CXL (ICR+CXL).
7 M 8,4 M
•The Mean interval between ICR and CXL was 7 months and the mean
interval between CXL and ICLToric implantation was 6,4 months.
•The preoperative and postoperative visual acuity, refraction,
pachymetry and topography results were evaluated.
•The mean follow-up period was 7.2 months.
METHODS
Channel creation
(INTRALASE FS 60): 15
seconds.
Depth adjusted to 80% of
the thinnest point at
tunnel location.
Corneal incision : at
steep axis.
Keraring:4.4-5.6 mm
+ +
ICL operations were
performed 8,4 months
after CCL
ICL calculation was
based on post op
ICR+CXL refraction
ACD> 2,8 mm
0,1% B2 in 20%
Dextran T-500 30 min
UV (Peschkemed)
370 nm 3 mW/cm² for
30 min
ICL operations were
performed 8,4 months
after CCL
MOST DIFFICULT ;
ICL calculation was
based on post op
ICR+CXL refraction
ACD> 2,8 mm
UCVA BCVA
Pre-Op 0,01 0,16
Post-ICR 0,06 0,46
Post-ICR+CCL 0,08 0,48
Post-ICL 0,46 0,58
0
0.1
0.2
0.3
0.4
0.5
0.6
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
0.01
0.060.08
0.46
0.16
0.460.48
0.58
UCVA & BCVA
UCVA BCVA
CYL SEQ
Pre-Op -4,73 -16,4Post-ICR -2,36 -9,81Post-ICR+CCL -1,88 -9,56Post-ICL -0,96 -0,8
-18
-16
-14
-12
-10
-8
-6
-4
-2
0Pre-OP Post-ICR Post-ICR+CXL Post-ICL
-4.73
-2.36 -1.88 -0.96
-16.4
-9.81 -9.56
-0.8
CYLINDER & SEQ
CYL SEQ
Mean K
Pre-Op 58,36Post-ICR 55,77Post-ICR+CCL 54,07Post-ICL 54,03
58,36
55,77
54.07 54.03
51
52
53
54
55
56
57
58
59
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
Mean K
K1
Pre-Op 56,16
Post-ICR 54,78
Post-ICR+CCL 53,54
Post-ICL 53,57
56,16
54,78
53.54 53.57
52
53
54
55
56
57
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
K1
56,1-54,7=1,4 D
K2
Pre-Op 60,57
Post-ICR 56,76
Post-ICR+CCL 54,61
Post-ICL 54,48
60,57
56,76
54.61 54.48
50
52
54
56
58
60
62
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
K2
60,5-56,7=3,8 D60,57-56,76=-3,81D
METHODS
7 M 8,4 M
<7 D
IrregularitySph<-18 D
Cyl<5 D
Stop Progression
<1,5D
Irregularity
CONCLUSION
Topo-Guided Transepithelial PRK ,Toric Phakic IOL
Implantation , ICR implantation followed by CXL is
an effective treatment sequence that can stop
progression and improve vision and refraction in
select keratoconus patients
However a long-term follow-up of a larger
population study is required to validate these
findings
THANK YOUefekan.coskunseven@dunyagoz.com
top related