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LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange. Ruth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt, Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Maarten Mourits, MD, PhD Retina Total Eye Care, Driebergen.

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LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange

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  1. LASIK & LASEK for Residual Refractive Errors After Refractive Lens Exchange Ruth Lapid-Gortzak MD, Jan Willem van der Linden, BOpt, Ivanka van der Meulen, MD, Carla Nieuwendaal, MD, Maarten Mourits, MD, PhD Retina Total Eye Care, Driebergen. Dept. of Ophthalmology, Academic Medical Center, Amsterdam The Netherlands R.Lapid@amc.nl R. Lapid has received speakers and Advisory board fees from Alcon, and an unrestricted research grant from Oculentis. The other authors have no financial interest.

  2. Bioptics: LASIK or LASEK after a lenticular intra-ocular procedure After RLE small refractive errors can cause significant complaints of VA No consensus for RLE or bioptics. What is the minimal refractive error or the minimal loss of lines on UDVA to consider a corneal laser procedure?

  3. Bioptics • Surprise in post-Restor SE or VA • Planned bioptics for pre-op corneal astigmatism Prospective case series. Single surgeon (RLG) for RLE and bioptics LASIK: XP microkeratome 120 micron flaps (Technolas) LASEK: 30 sec 20% alcohol Laser platform: Technolas z217 Planoscan

  4. Demographics • 45 eyes of 26 patients • Mean age 58.9 (range:51.5 - 66.17 years) • 80.7% males • 27 eyes LASEK, 18 eyes LASIK • Hyperopes 22 eyes, myopes 23 eyes

  5. Pre-operative data:

  6. Post-operative data LASIK:

  7. Post-operative data LASEK

  8. Attempted versus achieved sphere & cylinder correction after LASIK & LASEK after RLE Bot h graphs show mostly good congruency between attempted and achieved corrections. In the sphere corrections deviations from target were mostly undercorrections. With the cylinder corrections the deviations from target were more spread out.

  9. Safety and predictability at 3 and 6 months: Safety: we see that most patients did not loose or even gained lines. Loos of lines at 3 months was due To a residual refractive error. Efficacy: All were within 1.0D of Target refraction, at 6 months we see that close to 90% are within 0.5D of target refraction.

  10. Snellen VA before and after LASIK and LASEK in multifocal RLE LASIK Snellen VA pre-op (blue hues) versus post-op (red hues) Snellen lines Snellen lines LASEK

  11. Literature Piñero DP, Espinosa MJ, Alió JL, J Refract Surg. 2009 Nov 11:1-9 Good outcomes. Especially in myopes. Different types of multifocal IOL’s used and did not mention whether standard or wavefront treatment was used Muftuoglu et al, JCRS June 2009, p.1063-1071 Similar results in cataract patients with multifocal implants. Both standard tx and wavefront. Five different surgeons. Femtosecond laser used to create flap. No data on LASEK.

  12. Conclusion: • Bioptics for small refractive errors is predictable, effective, and safe. • RLE patients are very demanding • Multifocal toric will possibly decrease the need for bioptics • Wait with performing corneal laser procedure for post RLE tearfilm stabilization • YAG capsulotomy in our clinic is done on indication only

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