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Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan

Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan. 台灣諾貝爾醫療集團 張朝凱醫師 . 陳美齡醫師 . 王倫奕醫師 . 劉淳熙醫師 . 張鼎業醫師 . 林玉凰醫師 . 戴文瑛醫師 . 蕭清仁博士. Surface Ablation. This year( 2006 ) we went B to B Back to Bowman’s. Back to Bowman ’ s. There has been a significant movement back to surface ablation.

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Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan

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  1. Early Clinical Outcomes of Epi-LASIK for Myopia in Taiwan 台灣諾貝爾醫療集團 張朝凱醫師.陳美齡醫師.王倫奕醫師.劉淳熙醫師. 張鼎業醫師.林玉凰醫師.戴文瑛醫師.蕭清仁博士 2006年10月28日 中國廈門屈光手術研討會

  2. Surface Ablation • This year( 2006 ) we went B to B Back to Bowman’s 2006年10月28日 中國廈門屈光手術研討會

  3. Back to Bowman’s • There has been a significant movement back to surface ablation. • Major recent improvements in surface ablation include gradual blend zones and Mitomycin C for haze. 2006年10月28日 中國廈門屈光手術研討會

  4. Surface Ablation • Concerns for Lamellar Ablation • Deeper ablations due to larger ablation zones • Increased concern of ectasia • Improved visual results? • No flap related aberrations • Bowman’s membrane a more regular canvas than stroma 2006年10月28日 中國廈門屈光手術研討會

  5. Surface Ablation • Indications • Thin corneas • Patients predisposed to ocular trauma • Detachment surgery • Glaucoma • Flat corneas • Steep corneas • Deep-set eyes 2006年10月28日 中國廈門屈光手術研討會

  6. Surface Ablation • Relative to Lamellar ablation • No flap related complications • No striae • Less dry eye • No irregular flaps • No DLK 2006年10月28日 中國廈門屈光手術研討會

  7. Purpose • To evaluate initial clinical outcome with Epi-LASIK for myopia with astigmatism 2006年10月28日 中國廈門屈光手術研討會

  8. Methods • Three months results from a cohort of 56 eyes ( 30 patients ) that had Epi-LASIK procedureswith and without Flap Removal as well as PRK were studied .All operations were done with Amadeus 2 ( AMO, Santa Ana ,CA , USA ). 2006年10月28日 中國廈門屈光手術研討會

  9. Methods • For Epi-LASIK,epithelial separation was achieved mechanically without the use of alcohol. • The epithelial flap was remained (Option1) or removed (Option 2) and a therapeutic contact lens was applied to the cornea immediately for 3 to 5 days. • PRK patients were as usual • Postoperative epithelial defect size , symptoms, UCVA, BCVA were evaluated at three months postoperatively. 2006年10月28日 中國廈門屈光手術研討會

  10. Methods • Surgical Parameters • Oscillation speed: 11,000 rpm • Translation speed: 1.5 mm/sec • Suction: 22 mm Hg • Epithelial removal 9.0 mm 2006年10月28日 中國廈門屈光手術研討會

  11. Epi-LASIK 2006年10月28日 中國廈門屈光手術研討會

  12. What is Surface Ablation (Epi Lasik) ?Compare pig eye and human eye 2006年10月28日 中國廈門屈光手術研討會

  13. Option 1 (Flap Remain) 2006年10月28日 中國廈門屈光手術研討會

  14. Option 2 (Flap Removal) 2006年10月28日 中國廈門屈光手術研討會

  15. Methods • Epithelial defect size was measured with the slit lamp and recorded with digital photography daily until epithelial defects healed • Post-operative symptoms , UCVA, BCVA were studied • All patients received postoperative 0.1 FML qid for 3 weeks, Ciloxan qid for 1 week,, and BSS qid for over 6 weeks • Bandage contact lenses were removed after 4 days and corneas were stained with fluorescein 2006年10月28日 中國廈門屈光手術研討會

  16. Results • Epithelial Defect Size • Postoperative symptoms • UCVA • BCVA 2006年10月28日 中國廈門屈光手術研討會

  17. 1.Epithelial Defect Size (mm) Following Epi-LASIK, with and without Flap Removal, and PRK 2006年10月28日 中國廈門屈光手術研討會

  18. Patient 1(Epi - LASIK) 手術後第1天 手術後第3天 手術後第2天 手術後第5天 2006年10月28日 中國廈門屈光手術研討會

  19. Patient 2 (PRK) 手術後第5天 手術後第1天 手術後第3天 手術後第7天 2006年10月28日 中國廈門屈光手術研討會

  20. Fluorescing Stain Flap removal 48 hours Flap removal 24 hours Flap removal 72 hours PRK 24 hours PRK 48 hours PRK 72 hours 2006年10月28日 中國廈門屈光手術研討會

  21. 2.Pain Following Epi-LASIK, with and without Flap Removal, and PRK Pain significantly greater with PRK on day 1 and 3 2006年10月28日 中國廈門屈光手術研討會

  22. 3.UCVA Following Epi-LASIK, with and without Flap Removal, and PRK UCVA significantly better with flap removal on day 3 and 7 2006年10月28日 中國廈門屈光手術研討會

  23. 4.BCVA Following Epi-LASIK, with and without Flap Removal, and PRK BCVA significantly better with flap removal on day 3 and 7 2006年10月28日 中國廈門屈光手術研討會

  24. Discussion 1 • What are the advantages of Surface Ablation compared with Lasik? • He can do higher correction on thin cornea. • No stroma is leaving on the flap. • No cut through the stroma • Less risk by doing the flap 2006年10月28日 中國廈門屈光手術研討會

  25. Discussion 2 • Why is Surface Ablation not always used? • In average patients have more pain during the first 5 days post OP. • It is a little more difficult to handle a Surface Ablation flap than a Lasik Flap. • Surface Ablation does not substitute the Lasik: • Surface Ablation is a complementary method to Lasik. • Because of the wider range of possible patients, Doctor can operate about 12-17% more patients if he can use both systems. 2006年10月28日 中國廈門屈光手術研討會

  26. Discussion 3 • The most important initial event following surface ablation is for the corneal epithelium to heal as rapidly as possible as the outcome of surface ablation is closely related to the epithelial wound healing response.1 1Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg 2000. 2006年10月28日 中國廈門屈光手術研討會

  27. Discussion 4 • Delayed re-epithelialization increases • Time for visual rehabilitation • Incidence of postoperative haze • Pain and photophobia • Risk of infectious keratitis 1Fagerholm P. Wound healing after photorefractive keratectomy. J Cataract Refract Surg 2000. 2006年10月28日 中國廈門屈光手術研討會

  28. Discussion 1 • Epi –LASIK -Mechanical separation without alcohol preserves the integrity of the epithelium and stroma. • Partners well with wavefront-guided custom ablation. • This may allow for improved: • Comfort • Predictability • Visual recovery. 2006年10月28日 中國廈門屈光手術研討會

  29. Conclusion 1 • Epi-LASIK with the Amadeus II microkeratome removes the entire corneal epithelial layer with no discernible damage to the removed tissue or damage to Bowman’s membrane. 2006年10月28日 中國廈門屈光手術研討會

  30. Conclusion 2 • Epi-LASIK (with flap remain) with the Amadeus II microkeratome provides greater patient comfort than PRK or Epi-LASIK (with flap removal) during the immediate post-operative period 2006年10月28日 中國廈門屈光手術研討會

  31. Conclusion 3 • Epi-LASIK (with flap removal) with the Amadeus II microkeratome provides more rapid visual rehabilitation than PRK or Epi-LASIK (with flap remain) during the immediate post-operative period 2006年10月28日 中國廈門屈光手術研討會

  32. Conclusion 4 • We need long term studies to evaluate the efficacy of Epi-LASIK looking at • BCVA/UCVA • Corneal Haze • Corneal Sensitivity and Tear Function (AJO Volime 142 , issue 4 , Oct 2006) • Quality of vision and high order aberrations 2006年10月28日 中國廈門屈光手術研討會

  33. Thank you CONCLUSION • Epilasik for moderate to high myopia with the Amadeus II Epikeratome • Safe • Reproducible • Good patient satisfaction 2006年10月28日 中國廈門屈光手術研討會

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