sze h wong emil w chynn md mba maximiliano plana md emily ceisler md n.
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Sze H. Wong Emil W. Chynn, MD, MBA Maximiliano Plana, MD Emily Ceisler, MD. Treatment of Adult Amblyopes With Advanced Surface Ablation . ASCRS, May 2013 San Francisco, CA. LASEK / Epi -LASIK to treat amblyopes is not FDA-approved. PURPOSE.

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sze h wong emil w chynn md mba maximiliano plana md emily ceisler md
Sze H. Wong

Emil W. Chynn, MD, MBA

MaximilianoPlana, MD

Emily Ceisler, MD

Treatment of Adult Amblyopes With Advanced Surface Ablation

ASCRS, May 2013

San Francisco, CA

LASEK /Epi-LASIK to treat amblyopes

is not FDA-approved.

purpose
PURPOSE
  • Can adult strabismic and/or refractive amblyopes be safely and effectively treated with Advanced Surface Ablation (ASA)?
  • Can UCVA, BCVA, functional vision be improved?
  • Can strabismus be decreased?
slide3

METHOD

  • Retrospective review of adult amblyopes who underwent LASEK or Epi-LASEK with a VISX S4 IR excimer laser between 2006-2013
  • Adjunctive treatment to prevent scarring:
    • Mitomycin C (MMC) 0.01% intraoperatively
    • Oral + Topical steroids: 1-6 mo postop
    • Vitamin C + UV protection: 6-12 mo postop
results ucva safety
RESULTS: UCVA (safety)

UCVA

Log MAR

20/2000

error bar = sd

20/200

20/20

PreOp

PostOp (months)

  • Postop UCVA vs Preop UCVA:
  • 100% had improvement in UCVA
  • Corneal haze: trace 29%, 1+ 4%, 2+ 4%
  • There was no loss of UCVA (haze = clin. insig.)
slide6

RESULTS: BCVA (efficacy)

  • Postop vsPreop BCVA:
  • Mean gain of BCVA of 1.43 lines (± 1.11)
  • 87.5% had improved BCVA
results se vs bcva change in hyperopes
RESULTS: SE vs BCVA change in Hyperopes

Spherical Equivalent

Postop BCVA

Minus

Preop BCVA

(logMAR)

Correlation coefficient = 0.62

  • Hyperopic amblyopes with lower Rx have more BCVA improvement
results
RESULTS
  • Unilateral (anisometropic) amblyopes had a greater improvement in BCVA (2.5 lines) than Bilateral (isometropic) amblyopes (1.0 line) (1-tailed p value 0.04)
results1
RESULTS
  • FUNCTIONAL VISION
    • better peripheral vision: 63%
    • improved driving: 58%
    • increased sports ability: 29%
  • STRABISMUS
    • ET preop: 20Δ postop: 8Δ
    • UCVA preop: 20/200 postop: 20/30
    • BCVA preop: 20/30-1 postop: 20/25
    • Would do it again? YES! 
  • PATIENT SATISFACTION
    • 76% would undergo the operation again if given the choice
discussion
DISCUSSION
  • Adult strabismic/refractive amblyopes may be safely & effectively treated with ASA
  • No loss of UCVA (all scarring was clinically insignificant due to adjunctive measures)
  • Significant gains in BCVA & functional visual improvement, with excellent patient satisfaction
  • Better results for unilateral refractive amblyopes and low hyperopes
  • Further investigation is necessary, especially in strabismic amblyopes (low n)
references
REFERENCES
  • Tychsen L. Refractive surgery for children: excimer laser, phakic intraocular lens, and clear lens extraction. Curr Opin Ophthalmol. 2008 Jul;19(4):342-8.