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University of California, San Diego Shiley Eye Center

L. University of California, San Diego Shiley Eye Center. Myoung Joon Kim, MD / Sara Yoon, MD Tracy Purcell, PhD / David J Schanzlin , MD. aser In Situ Keratomileusis versus Photorefractive Keratectomy for the Treatment of Myopia with CustomVue Platform.

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University of California, San Diego Shiley Eye Center

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  1. L University of California, San Diego ShileyEye Center MyoungJoon Kim, MD / Sara Yoon, MD Tracy Purcell, PhD / David J Schanzlin, MD aser In Situ Keratomileusis versus Photorefractive Keratectomy for the Treatment of Myopia with CustomVue Platform No author has a financial or proprietary interest in any material or method mentioned.

  2. INTRODUCTION • CustomVue platform provides a wavefront-guided treatment • to correct refractive errors. • Literature shows: LASIK Minimal postoperative pain Faster visual recovery Less regression No haze Flap-related complications Interface-related complications Corneal biomechanical instability PRK Safe and effective Postoperative pain Slow visual recovery Corneal haze

  3. INTRODUCTION • Previous studies • Few studies have compared LASIK and PRK • using CustomVue Platform.§ • PURPOSE • To compare the outcomes of LASIK and PRK • in wavefront-guided treatment of low to moderate myopia • using CustomVue Platfrom • § • Wavefront-guided laser in situ keratomileusis using the WaveScan system for correction • of low to moderate myopia with astigmatism: 6-month results in 277 eyes. J Cataract Refract Surg 2005. CustomVue laser in situ keratomileusis for myopia and myopic astigmatism • using the Visx S4 excimer laser: Efficacy, predictability, and safety. J Cataract Refract Surg 2006. • Wavefront-guided laser in situ keratomileusis in the treatment of high myopia • by using the CustomVue wavefront platform. Cornea 2008.

  4. METHODS • Retrospective control-matched design • Duration: Jan. 2006 ~ Dec. 2007 • Preoperative manifest sphere ≤ -6 D, Cylinder ≤ 2 D • Matching criteria: Sphere within ± 1 D, Cylinder within ± 1 D • Age within 10 years • Primary procedure performed in the same year • Exclusion criteria: Preoperative BSCVA < 20/25 • Follow-up duration less than 3 months

  5. METHODS • Procedure • One surgeon (DJS) • LASIK flap creation with IntraLase • Myopic wavefront-guided treatment targeted at plano • Mitomycin0.02% used in PRK • Laser platform: VISX STAR S4 IR (AMO, Santa Ana, CA) • Wavefront analysis • Between postoperative 1 and 3 months • WaveScan (AMO, Santa Ana, CA) • Outcome Analysis Software v4.0 (Outcome Analysis Software, • Inc, San Diego, CA)

  6. RESULTS 46 eyes matched (23 eyes per each group) Patients age LASIK group 35.5±9.7 years PRK group 36.2±12.5 years P=0.92 Preoperative refractive errors LASIK group SPH -4.10±1.48 D (range -1.75 ~ -6.00) CYL 0.86±0.53 D (range 0 ~ +1.75) PRK group SPH -3.97±1.45 D (range -1.00 ~ -6.00) CYL 0.82±0.51 D (range 0 ~ +1.75) P=0.55 for SPH, 0.77 for CYL

  7. RESULTS • Mean UCVA at 1 month, LogMAR • LASIK • 0.03±0.17 • (LogMAR 0.03 = 20/21.3) • Mean UCVA at 3 months, LogMAR • LASIK • 0.00±0.15 • (LogMAR 0.00 = 20/20.0) • Mean UCVA at last follow-up, LogMAR • LASIKmean 11.3 months • -0.08±0.07 • (LogMAR -0.08 = 20/16.7) PRK 0.04±0.08 (LogMAR 0.04 = 20/22.0)P=0.75 PRK 0.03±0.15 (LogMAR 0.03 = 20/21.3)P=0.61 PRKmean 11.6 months -0.07±0.10 (LogMAR 0.03 = 20/17.2) P=0.57

  8. RESULTS • Cumulative UCVA (Snellen) % % PRK LASIK

  9. RESULTS LASIK Among higher-order aberrations, only rms of total higher-order aberration showed statistically significant change (P=0.025). Coma and spherical aberration showed tendency to be increased (P=0.054, 0.055).

  10. RESULTS PRK Among higher-order aberrations, none of them showed statistically significant change after PRK (P>0.05).

  11. DISCUSSION In LASIK, higher-order aberrations increased significantly postoperatively. Out of components of higher-order aberration, coma and spherical aberration showed tendency to be increased. Radially symmerical component (spherical aberration) may be induced by laser ablation pattern and radially asymmetric component (coma) may be related with flap of LASIK (hinge itself , opaque bubble layer around hinge at the time of flap creation by femtosecond laser). CONCLUSION Both femtosecond laser LASIK and PRK showed similar good visual outcomes in wavefront-guided treatment of myopia using CustomVue Platform.

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