One Use-PlusSBK versus LDV Femto Laser Clinical evaluation

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1 One Use-PlusSBK versus LDV Femto Laser Clinical evaluation Nikica Gabric, Maja Bohac, Iva Dekaris Eye Clinic Svjetlost Zagreb, Croatia

2 MORIA ONE USE-PLUS SBK MICROKERATOME Automatic linear microkeratome Adjustable advance rate -2 or 3 second pass Cutting mechanism blade rpm oscillations per minute Flap diameter up to 10.5 mm Head size 90 and 130 µm Flap depth avg. 100 and 130 µm respectively(speed 2) Flap orientation nasal

3 ZIEMER FEMTO LDV Cutting mechanism photodisruption Flap diameter 8.5 mm, 9.0 mm, 9.5 mm, 10.0 mm Flap depth 90 µm, 110 µm, 140µm Variable flap orientation (inferior, superior, nasal, temporal) Repetition rate 1.0 MHz Laser pulse duration fs Laser Wavelength nm Spot size < 2 µm Vacuum level mbar. Induced IOP < 50 mmhg

4 PURPOSE Prospective study on 60 patients (120 eyes) who underwent LASIK procedure with flap creation either with Moria One Use-PlusSBKmechanical microkeratome or Ziemer FEMTO LDV laser for evaluation of flap and stromal bed quality, visual and refractive outcome and patients satisfaction.

5 PATIENTS 60 patients (120 eyes) divided in two groups First group underwent LASIK surgery with Moria One- Use PlusSBK, and the other group underwent LASIK surgery using LDV Femtolaser for flap creation Mean age in both groups was 35 ±15 years Mean SE was D (ranging from to D) Mean corneal thickness was 540±40μm Mean keratometry values were 44±4D. All curvature and elevation maps were normal. Patients denied any previous ocular or sistemic conditions and slit lamp biomicroscopy was unremarkable.

6 METHODS Evaluation of flap profile with Pentacam and Anterior Visante OCT in several axis Complication rate (intraoperative and postoperative) Time of procedure Quality of resection, flap and stromal bed quality Visual outcome at Day 1, Week 1, Month 1, and Month 3 after the surgery Patients pain/discomfort during the surgery and in first hours and days after the surgery Postoperative dry eye (Schirmer test, patients questionaire)

7 INTRAOPERATIVE COMPLICATIONS MORIA ONE USE PLUS MECHANICAL MICROKERATOME ZIEMER FEMTO LDV LASER Decentred flaps 1 1 Small irregular flaps 0 1 Thin flaps 0 0 Free flaps 0 0 Epithelial defects 1 0 Buttonholes 0 0

8 POSTOPERATIVE COMPLICATIONS MORIA ONE USE PLUS MECHANICAL MICROKERATOME Distorted flaps 0 0 Flap strie 1 0 Infection 0 0 Sterile infiltrates 0 0 Deep lamelar keratitis 0 1 Epithelial ingrowth 0 0 ZIEMER FEMTO LDV LASER

9 FLAP AND CORNEAL BED QUALITY MORIA SBK

10 FLAP AND CORNEAL BED QUALITY FEMTO LDV

11 FLAP THICKNESS AND POSITION MORIA OUP SBK ESCRS, Paris, 2010.

12 FLAP THICKNESS AND POSITION FEMTO LDV ESCRS, Paris, 2010.

13 UNCORRECTED VISION FIRST DAY POSTOPERATIVE 50% 40% 30% 20% 10% 0% 20/16 or 20/20 or 20/25 or 20/40 or MORIA SBK FEMTO LDV

14 UNCORRECTED VISION ONE WEEK POSTOPERATIVE 70% 60% 50% 40% 30% 20% 10% 0% 20/16 or 20/20 or 20/25 or 20/40 or MORIA SBK FEMTO LDV

15 UNCORRECTED VISION ONE MONTH POSTOPERATIVE 70% 60% 50% 40% 30% 20% 10% 0% 20/16 or 20/20 or 20/25 or 20/40 or MORIA SBK FEMTO LDV

16 UNCORRECTED VISION THREE MONTHS POSTOPERATIVE 80% 60% 40% 20% 0% 20/16 or 20/20 or 20/25 or 20/40 or MORIA SBK FEMTO LDV

17 PATIENTS DISCOMFORT MORIA ONE USE PLUS MECHANICAL MICROKERATOME No to slight discomfort during the surgery No to slight discomfort on Day 1, 7 or in the first month after the surgery BLACKOUT PHENOMENA8 15 sec PROCEDURE TIME 3,5-5 min ZIEMER FEMTO LDV LASER Slight to moderate discomfort during the surgery No to slight discomfort on Day 1, 7 or in the first month after the surgery BLACKOUT PHENOMENA 55 sec PROCEDURE TIME 8-12 min *Moria M2 single use blackout phenomena 8 15 sec Procedure time min

18

19

20 POSTOPERATIVE DRY EYE Patients questionare DRY EYE SIMPTOMS ( blurr, redness, pain ) MORIA ONE USE PLUS MECHANICAL MICROKERATOME none some 5 7 moderate 3 3 severe 0 0 ZIEMER FEMTO LDV LASER

21 SCHIRMER S TEST RESULTS Preope... 1 wee... 1 mon.. 3 mon.. MORIA SBK FEMTO LDV

22 CONCLUSION Visual and refractive results in myopic cases were the same in both groups ONE USE-PLUS SBK slightly results in flap and corneal bed quality, intraoperative visibility, easier handling and less patients discomfort during the surgery sligthly weaker results in hyperopic cases due to dependency of ring and ablation zone sizing according to K values and nasal flap orientation

23 CONCLUSION 1 FEMTO LDV Better result in hyperopic cases due to wider corneal bed and ablation zone independent on K values The bigest disadvantage is too long blackout phenomena (55 sec vs 8 sec), poor intraoperative visibility and patients discomfort

24 Thank You for your attention!

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