paolo vinciguerra, md1, 2paolo vinciguerra m.d. why a new strategy for ptk? (2) •using the...

Paolo Vinciguerra, MDPaolo Vinciguerra, MD1, 21, 2Fabrizio I. Camesasca, MDFabrizio I. Camesasca, MD11

11Dept. of Dept. of OphthalmologyOphthalmology,,Istituto Clinico HumanitasIstituto Clinico Humanitas

22Columbus, Ohio State UniversityColumbus, Ohio State University

TransepithelialTransepithelial Custom Custom Ablation for Retreatment Ablation for Retreatment After Refractive SurgeryAfter Refractive Surgery

Paolo Vinciguerra M.D.Paolo Vinciguerra M.D.

Why a new strategy for PTK? (1)Why a new strategy for PTK? (1)

••Not enough tissue available for Not enough tissue available for standard or custom PTKstandard or custom PTK

••Unpredictable epithelial Unpredictable epithelial thickness (CLthickness (CL‐‐related or other related or other scarring) masks real stromal scarring) masks real stromal thickness and makes it impossible thickness and makes it impossible to assess if the problem can be to assess if the problem can be fixedfixed


Why a new strategy for PTK? (2)Why a new strategy for PTK? (2)••Using the epithelium as if it were Using the epithelium as if it were stroma, and applying custom stroma, and applying custom ablation to the epithelium, makes ablation to the epithelium, makes it possible to focally ablate the it possible to focally ablate the stroma and still achieve stroma and still achieve significant visual improvement. significant visual improvement. This at the cost of only a minimal This at the cost of only a minimal amount of stromal tissue amount of stromal tissue


Technique of Technique of transepithelialtransepithelialapproachapproach

•• Step 1Step 1•• Custom ablation of Custom ablation of the corneal surface ( the corneal surface ( Epithelium and Epithelium and stroma)stroma)

•• Step 2Step 2••Dry ablation of 60 Dry ablation of 60 micron of tissue micron of tissue with an even 10 mm with an even 10 mm diameter zonediameter zone

•• Step 3Step 3•• Smoothing with Smoothing with masking fluid and masking fluid and intraopintraop topographytopography

•• Step 4Step 4•• Custom refinement if Custom refinement if neededneeded

•• Step 5Step 5•• Repeat if needed steps Repeat if needed steps 3,4 3,4


NonNon‐‐transepithelialtransepithelial IntraoperativeIntraoperative

•23 eyes •Mean age 39 years (from 20 to 68)•OPD-based NIDEK Final Fit•EC 5000 NIDEK excimer laser

pre SR equiv: mean -1,02 D ± 4,57 D (from -9,00 to 12,38)pre SR sph: mean -0,52 D ± 4,71 D (from -9,00 to 13,50)pre SR cyl: mean -0,99 D ± 1,18 D (from -4,00 to 2,00)

•Follow up: one year•20 eyes (87.0% follow up rate)

post SR equiv: mean 1,04 D ± 5,54 D (from -9,75 to 11,25)post SR sph: mean 1,75 D ± 5,47 D (from -8,50 to 13,00)post SR cyl: mean -1,43 D ± 1,29 D (from -4,75 to 0,00)

Materials Materials and and MethodsMethods


5%

32%

8%

25% 26%23%25%

5%

23%

13%

32%

46%

38%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pao

lo V

inci

guer

ra, M

D

lost > 2 lost 2 lost 1 unchanged gained 1 gained 2 gained > 2

SAFETY: Change in BSCVA - Percent

1 (19)3 (13)6 (8)12 (2)

month(eyes)


5%8% 5%

31%38%

26%

8%

50%

16%15%

25%

50%

8%

47%

31%38%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pao

lo V

inci

guer

ra, M

D

20/12 orbetter

20/15 20/20 20/25 20/30 20/40 20/50 orworse

BSCVA - Percent

1 m (19)3 m (13)6 m (8)1 y (2)

month(eyes)


50%

100%

50%

100%

13%

50%

100%

13%

100%100%

26%

100%100%

26%

100%100%

39%

61%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pao

lo V

inci

guer

ra, M

D

'20/10' 20/12 orbetter

20/15 orbetter

20/20 orbetter

20/25 orbetter

20/30 orbetter

20/40 orbetter

20/50 orbetter

20/60 orworse

preOP BSCVA vs. postOP UCVA - Percent

1 m (2)3 m (1)preSCVA (23)

month(eyes)


BSCVA over Time

0,730,640,60

0,43

0,29

23 19 13 8 2-0,2

0,0

0,2

0,4

0,6

0,8

1,0

1,2

1,4

0 1 3 6 12

Paol

o Vi

ncig

uerr

a, M

D

6/6 20/20

6/5 20/15

6/8 20/25

6/10 20/30

6/15 20/50

6/30 20/100


BSCVA over Time

0,96 1,00

0,69

0,800,84

0,700,60

0,43

1449 41 33 25 23 60,0

0,2

0,4

0,6

0,8

1,0

1,2

1,4

0 1 3 6 12 18 24 36

Paol

o Vi

ncig

uerr

a, M

D

6/6 20/20

6/5 20/15

6/8 20/25

6/10 20/30

6/15 20/50

6/30 20/100

ArrivederciArrivederciSeptember 16September 16‐‐18, 18,

20062006

RefrRefr@@ctivective.on.on‐‐lineline

paolo vinciguerra, md1, 2paolo vinciguerra m.d. why a new strategy for ptk? (2) •using the...

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