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Corneal Wavefront -guided PRK with MMC to treat Hyperopia after Radial Keratotomy

Corneal Wavefront -guided PRK with MMC to treat Hyperopia after Radial Keratotomy. Ramon C. Ghanem 1,2 Emir A. Ghanem 1 Vinícius C. Ghanem 1,2 Newton Kara -José 1,2. 1. Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil. 2. University of São Paulo (USP), São Paulo, Brazil . 100372 .

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Corneal Wavefront -guided PRK with MMC to treat Hyperopia after Radial Keratotomy

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  1. Corneal Wavefront-guided PRK with MMC to treat Hyperopia after Radial Keratotomy Ramon C. Ghanem1,2 Emir A. Ghanem1 Vinícius C. Ghanem1,2 Newton Kara-José1,2 1. Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil. 2. Universityof São Paulo (USP), São Paulo, Brazil. 100372

  2. Financial Disclosures The authors do not have a commercial or proprietary interest in this work. RC. Ghanem, Poster WCC 2010

  3. Introduction • Hyperopia after Radial Keratotomy (RK) • PERK: 43% hyperopic shift > 1 D at 10 years1 • After RK corneas are flat, irregular and biomechanically unstable1 • Need for customized ablation • LASIK  many complications2-7 • Opening of the RK incisions during flap lift • Epithelial ingrowth, buttonhole flap, DLK, ectasia3,9,10 • PRK  risk of haze11-13 • Increased with topography-guided ablations (deeper) 13 • Decreased with the use of Mitomycin-C (MMC)13 1. Waring 1994; 2. Francesconi 2002; 3. Lyle 2003; 4. Munoz 2006; 5. Linebarger 2000; 6. Clausse 2001 7. Oral 2005; 8. Afshari 2005; 9. Chan 2003; 10. Munoz 2005; 11. Venter 1997; 12. Hoyal 2003; 13. Ghanem 2008 RC. Ghanem, Poster WCC 2010

  4. Purpose Study corneal wavefront-guided PRK with MMC 0.02% for correcting hyperopia and astigmatism after RK Prospective study, 70 eyes of 42 patients Hyperopia up to +8.50 D; astigmatism up to -4.5 D Mean of 19 years after RK Mean of 7.8 RK incisions per eye (4 to 14) 37% had between 1 and 4 AK incisions Esiris-SchwindCorwave® (ø up to 10-mm OZ) Preoperative corneal wavefront analysis was performed with a Keratron Scout Topographer MMC 0.02% for 20 to 40 seconds Methods RC. Ghanem, Poster WCC 2010

  5. Results Spherical Equivalent (SE) Preoperative Mean SE was +4.2 D ± 2.0 At 12 months Mean SE was -0.1 D ± 1.0 (P<0.001; WilcoxonTest), RC.Ghanem, Poster WCC2010

  6. Predictability

  7. Safety - BSCVA

  8. Safety – Corneal Haze

  9. Corneal High-Order Aberrations

  10. Complications Corneal Haze Case examples Central haze 1+ Peripheral haze 2+ Paracentralhaze 3+ RC. Ghanem, Poster WCC 2010

  11. Complications • One eye developed keratectasia due to widening of an inferior radial incision six months after surgery. Fem, 47y, RK in 1987 (-3,00) A-before PRK B-ablationprofile C-after 6 mothsD-after 24 months RC. Ghanem, Poster WCC 2010

  12. Conclusion Customized surface ablation is becoming the technique of choice for hyperopia after RK Corneal WF-guided PRK with MMC for hyperopia and astigmatism after RK showed Good efficacy, predictability and stability Favorable safety profile Significant improvement in BSCVA 1. Absence of flap-related complications 2. “Topography-guided” ablation with a large ablation zone 2.1 treatment of corneal irregularities / increase of corneal curvature 2.2 decrease high order aberrations 3. Use of MMC, which reduces haze formation No patient developed significant haze Avoid PRK on widened RK incisions Suture before! Thank you RC. Ghanem, Poster WCC 2010

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