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Authors : Jaroslav Madunicky , MD Katerina Buusova Smeckova , MD, MBA

Segment Implantation to the Tunnel Created by the Femtosecond Laser: Evaluation of One Year Results. Authors : Jaroslav Madunicky , MD Katerina Buusova Smeckova , MD, MBA Col . Assoc.Prof . Jiri Pasta, MD, PhD. Iveta Nemcova , MD, PhD. Eva Vyplasilova , MD Kristina Hakucova , MD

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Authors : Jaroslav Madunicky , MD Katerina Buusova Smeckova , MD, MBA

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  1. Segment Implantation to the Tunnel Created by the Femtosecond Laser: Evaluation of One Year Results Authors: Jaroslav Madunicky, MD KaterinaBuusovaSmeckova, MD, MBA Col. Assoc.Prof. Jiri Pasta, MD, PhD. Iveta Nemcova, MD, PhD. Eva Vyplasilova , MD Kristina Hakucova, MD Department of Ophthalmology of the First Faculty of Medicineof Charles University and Central Military Hospital, Prague Noneoftheauthors has a financialinterest on thepresented data.

  2. Purpose • To evaluatethechangeofchange in the refractive error, BCVA, pachymetry and corneal topography of 50 patients, who underwentin ourClinicsince 2009 uni- or bilateral implantation of the keraring(s) using the femtosecond laser iFS 150 following Madunicky Formula. • To statistically evaluate effect based on the degree of keratoconus (I-IV) and max. keratometry localization.

  3. Setting / Venue

  4. Methods • Prospective, unmasked, non-randomized study of 50 patients with keratoconus (53 eyes), grade 2 to 3-4, who underwent the implantation of SI-5 Keraring/s. • Degree of keratoconus and type of ectasia according to the localization of maximal keratometric readings were determined, other pathologies were described. • Preoperatively and 1, 6 and 12 months postoperatively UCVA, BCVA, autorefractometry, pachymetry measurements and keratometry readings were obtained. • Implantation of keraring/s was performed in local anesthesia implanted into the tunnel created by Intralase iFS 150 set according to the Madunicky Formula. No peroperative complications were reported. • Ring was selected according to the currently valid nomogram and preoperative examination of the patient.

  5. MADUNICKY´S FORMULA DF = (0.8 TP x AC) - (SC x RC) DF = (0.8 TP x 0.92) - (-20 x 0.5/0.1) DF: Depthofthefemtotunnel (µm) TP: Thinnest pachymetry (µm) AP: Applanationcoefficient SC: Safetycoefficient (µm) RC: Ring coefficient

  6. Results I. MeanUCVA-1M,6M and 12 M after implantation UCVA 12 Months after Procedure

  7. Results II: Evaluationof UCVA & BCVA • -1,34Dsf/-3,76Dcyl=0,63 • 0,25 +/- 0,02 [0,05;0,5] • -1,81Dsf/-1,82Dcyl=0,63 • 0,34 +/- 0,03 [0,1;0,7] • 0,44 +/- 0,05 [0,2;0,8] • -2,50Dsf/-2,4Dcyl=0,63 • 0,41 +/- 0,07 [0,2;0,9] Improved by 1,61D of SE

  8. Results III. Change in pachymetry Change in K max. and grade

  9. Results IV.: EvaluationofAutorefractometry & Pachymetry • 459,52 [426;500] um • -4,57Dsf/-5,78Dcyl • 469,14[423;583] um • -2,42Dsf/-2,87Dcyl • -3,45Dsf/-2,75Dcyl • 471,14[438;527] um • -2,39Dsf/-2,17Dcyl Improved by 5,79 D of SE Improved by 18,25 [3;31]

  10. Results V. • In the interval of 1 year of the implantation 2/3 of patients have improved both their UCVA and BCVA. Statistically are the most succesfull group grade II and III. In this group there is no worsening of the BCVA, in 1/3 it only remained unchanged. Vision of 11% of patients in the group grade III-IV got worse during this period. • In a group grade II-III is more expressive the change of the SE, as the flattening of the extasia. • Ring dislocation • Optical phenomenon Complications

  11. Comparisonofpossible keratoconus treatments

  12. Conclusion • Keraring implantation with the iFS 150 following Madunicky Formula and up-to-date nomograms, when performed by an experienced surgeon, seems to be a safe and full-valued treatment, which helps patients on their way to stabilize the disease and to postpone the need to perform a perforativekeratoplasty. • Theeffectofimplantationisquiteindividualanditdepends on thedegreeofdisease, progression / stability ofthediseaseandthelocationoftheectasia in thecornea (depth, symetry). • On ourclinicweperformtheimplantationoftheintrastromalsegmentsonlywiththefemtosecond laser set according to theMadunickyFormula. Theresultsseem to beveryperspective. Theprocedureitselfislessstressfulforbothpatientandsurgeonandwehave not reportedso far any case ofextrusionorperforation.

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