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P R K in 2005

P R K in 2005. Bernard Mathys, MD Brussels. Brief history. 15 Y of follow-up Excimer laser Relatively easy technique Short learning curve. Limits. Pain Regression Haze ( > -6D). PRK fights back. Complications of Lasik Epithelial ingrowth Striae, folds SOS Ectasia

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P R K in 2005

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  1. P R Kin 2005 Bernard Mathys, MD Brussels www.drmathys.be BSCRS 2005

  2. Brief history • 15 Y of follow-up • Excimer laser • Relatively easy technique • Short learning curve www.drmathys.be BSCRS 2005

  3. Limits • Pain • Regression • Haze ( > -6D) www.drmathys.be BSCRS 2005

  4. PRK fights back • Complications of Lasik • Epithelial ingrowth • Striae, folds • SOS • Ectasia • Flap induced HOA • Problem flap size/wide OZ for hyperopia www.drmathys.be BSCRS 2005

  5. PRK improved • Improved lasers: scanning, flying spot, Gaussian • Improved OZ, transition Z, blend Z • Improved nomogram • Improved tracker: centration, cyclotorsion, frequency, mechanical response ? • Aspheric profile: better for HOA ? www.drmathys.be BSCRS 2005

  6. Advantages • Limits induced HOA • Lower rate of irregular astigmatism • Wave-front guided: Fourier > Zernicke ? • Customized treatment www.drmathys.be BSCRS 2005

  7. Results www.drmathys.be BSCRS 2005

  8. No higher RMS postop for high correction • No higher RMS postop for large OZ • Seems to reduce RMS for OZ 6 – 6.5 • Safe and effective: no loss of VA www.drmathys.be BSCRS 2005

  9. RMS changes www.drmathys.be BSCRS 2005

  10. And so…PRK, Lasek > Lasik ? • Flap induced HOA: nomogram correction • FDA studies for Lasik. PRK ? • In fact, photoablation creates HOA !! • No « real » studies in litterature www.drmathys.be BSCRS 2005

  11. PRK Follow-up • Pain • Fluctuations • Haze www.drmathys.be BSCRS 2005

  12. PRK best treatment • Corneal cooling • Quick removal of the epithelium • CL • AINS (ketorolac) 3d • Tears • Steroïds ? www.drmathys.be BSCRS 2005

  13. AINS (ketorolac) www.drmathys.be BSCRS 2005

  14. PRK haze ? • Activated keratocytes – collagen I-III • More frequent if: • delayed epithelial response • deep ablation, > -9D • broad beam, more energy, retreatment Gabbato,Ophtal. online, dec 2004 • Max 3 to 6 M • Decreases with time: metalloprotease Kato • After 1 Y: scar • MMC 0.02% 2 min www.drmathys.be BSCRS 2005

  15. Best healing response ? • Amniotic membrane ? • Interferon ? • Growth factor ? • PA ? www.drmathys.be BSCRS 2005

  16. So…PRK indications ? • Up to -5 D • K < 39 and > 48 • KT subclinical • Thin cornea • Dry eyes • High astigmatism • Army, pilots, athlete www.drmathys.be BSCRS 2005

  17. Even more indications… • Hyperopes • Refraction error after IOL • Refraction error after RK • Refraction error after corneal graft www.drmathys.be BSCRS 2005

  18. PRK after RK www.drmathys.be BSCRS 2005

  19. And PTK ? • Irregular astigmatism • Recurrent erosion • Reshaping • Herpes (under treatment) www.drmathys.be BSCRS 2005

  20. Then: • Do not be ashamed to perform PRK • Many indications • Haze problems tend to diminish • Lasek = disguised PRK • Not a single ectasia after PRK • Good PRK much better than a bad Lasik !! www.drmathys.be BSCRS 2005

  21. Good PRK >< Bad Lasik www.drmathys.be BSCRS 2005

  22. Thin corneas www.drmathys.be BSCRS 2005

  23. Follow-up 1 Y www.drmathys.be BSCRS 2005

  24. Limited induced aberrations www.drmathys.be BSCRS 2005

  25. High astigmatism www.drmathys.be BSCRS 2005

  26. Same patient, topography www.drmathys.be BSCRS 2005

  27. Thank you for your attention www.drmathys.be BSCRS 2005

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