Epi-Lasik Versus PTK Epithelial Removal: Contralateral Eye Study

1. Epi-Lasik Versus PTK Epithelial Removal: Contralateral Eye Study Daniela Jardim, MD; Gustavo Bonfadini, MD; Frederico Guerra, MD; Fernanda Fonyat, MD Bruno Valbon, MD; Renato Ambrosio JR MD, PhD Rio de Janeiro - Brasil Dr. Ambrósio is a consultant for Oculus and is on the speaker bureau for Reichert, Allergan, Alcon and Moria.

2. Rio de Janeiro Corneal Tomograhyand Biomechanics Study Group Renato Ambrosio Jr, MD, PhD Marcella Salomão, MD Frederico Guerra, MD Daniela Jardim, MD Bruno Valbon, MD Gustavo Bonfadini, MD Simone Boghosian, MD Renata S. Siqueira, MD Fernanda Fonyat, MD Ricardo Valente, MD Ruiz Simonato, MD Bruno M. Fontes, MD

3. LASIK Advantages Faster Visual Rehabilitation (“Wow factor”) High Comfort Level Lower risk of Corneal Infections Better for Enhancements Disadvantages Flap Complications DLK Neurotrophic Epitheliopathy and Dry Eye Risk of more complex Corneal Infections Iatrogenic Keratectasia

4. Why Surface Ablation? No Flap related Complications Less Biomechanical Impact on the Cornea Minor Impact on Ocular Surface after Epithelial Healing Better registration of custom treatments Improvements on Corneal Ablations and Wound Healing modulation to decrease Haze BUT, still has slower visual rehabilitation and discomfort during the first two to seven days

5. How to do for Surface Ablation? Traditional Manual Epithelial Scrape Alcohol-assisted Epithelial removal LASEK Epi LASIK Transepithelial PTK-PRK

6. Epi-LASIK Concept Epithelial flap (No alcohol ) Minimal pharmacological or chemical exposure to the epithelium More vital epithelial layer allowed for less pain and speedier recovery. Alcohol has a sinergic effect for keratocyte depletion with mitomycin C Cleavage principle Angle of blade to epithelium allows for cleavage of the epithelial layer without cutting Cleavage follows along plane of least resistance by separating and rupturing this plane Cleavage at the level of the basement membrane appears to allow for a viable epithelial layer Implications of better wound healing? * Pallikaris, IG et al. Epi-LASIK: Comparative histological evaluation of mechanical and Alcohol-assisted epithelial separation. J Cataract Refract Surg 2003; 29:1496-1501

7. Epi-LASIK x ePTK (Laser Epithelial Removal) Epi-LASIK ePTK – PRK (Allegretto Eye Q)

8. Epi-LASIK x ePTK :VISUAL RECOVERY AND SUBJECTIVE PER AND POST-OPERATIVE DISCOMFORT Contralateral eye prospective study So far: 11 patients (22 eyes) Range from -1.75 to -8.00 (S.E.) All Eyes had epithelial healing by day 5 Low scores of pain and discomfort 4/5 preferred e-PTK procedure 3/5 preferred Epi-LASIK in the first 4 to 72 hours All cases had 20/40 or better UCVA after CLs removal

9. Which eye do you prefer? DURING PROCEDURE

10. Which eye do you prefer? FIRST DAY POST-OP

11. Subjective Discomfort Level Comparison on ePTK x EpiLASIK (during surgery and first week)

12. Conclusion Advanced Surface Ablation can be performed by different ways We believe that epithelial flap formation with EpiLASIK and epithelial ablation with the PTK mode are the best choices today During the surgery, most patients preferred the epithelial ablation with the PTK mode procedure. However Epi-Lasik provided less discomfort in the first three days after surgery. Either techniques provided good outcomes. Long term follow up is needed, along with a bigger sample to elucidate if there is any differences in terms of haze formation and vision quality.