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Intra-stromal vs. Sub-epithelial Ablation. LASIK flap presents biomechanical problems for optimal ablationHinge contributes to irregularity and may increase comaPost-op dryness may cause irregular healingLoss of stretch effect when cutting collagenSurface treatment has certain unique biochemical healing risksApoptosis with scarring and irregular collagen formationSlower healing characterized by pain and early poor acuity.
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1. Epi-LASIK with Moria Epi-K: Compared to PRK, LASEK, and LASIK Barrie D. Soloway, MD, FACS
Director, Vision Correction
Assistant Professor, Ophthalmology
New York Eye and Ear Infirmary
2. Intra-stromal vs. Sub-epithelial Ablation LASIK flap presents biomechanical problems for optimal ablation
Hinge contributes to irregularity and may increase coma
Post-op dryness may cause irregular healing
Loss of stretch effect when cutting collagen
Surface treatment has certain unique biochemical healing risks
Apoptosis with scarring and irregular collagen formation
Slower healing characterized by pain and early poor acuity
3. Epi-LASIK: a marriage of two technologies Compared to other surface methods, a viable epithelial flap may:
Decrease post-op pain
Restore good acuity faster
Decrease the formation of post/op healing haze
Compared to LASIK, a viable epithelial flap may improve custom wavefront surgery results:
Decrease the irregularity caused by the LASIK flap hinge
Decrease the adverse biomechanical effects of cutting collagen in LASIK
Decrease the effects of the LASIK flap being larger than the resultant bed and microstriae
4. Purpose of this Study To compare 4 refractive surgical treatments,
LASIK with thin flaps
Epi-LASIK
PRK with
Mechanical epithelium removal and
Trans-epithelial PRK
Analyzing the efficacy and safety.
5. MATERIAL AND METHODS Prospective study
80 eyes, 20 eyes per group.
Equivalent demographic date with NSSD
Age: 23-48 years
SE: -2 to -9 D (astigm < 3 D)
Pachymetry > 500 mirons
Standard inclusion-exclusion criteria
6. MATERIAL AND METHODS Topical anesthesia
Allegreto 400 Q Wave Light (Q adjusted)
LASIK: M2 90 SU, flaps 83 – 127 µ
Epi-LASIK: MORIA Epi-K, removing the epithelium
PRK (MtMC 0.02% 15 sec every 50 µ ablation)
Mechanical with brush
Trans-epithelial PRK : Allegreto PTK 9.5 mm, 50 µ
7. MATERIAL AND METHODS Corneal Hysteresis
Discomfort,
Visual recovery
Wavefront testing
8. MATERIAL AND METHODS Cold BSS at start and end of surgery
Acuvue ® contact lens soaked with Lidocaine 1%, during surgery
Acular ®, Tobradex ®, TID.
PF artificial tears
9. LASIK Results - FLAP THICKNESS M2 SU-90
Ultrasound intra-op. 94.63 µ (sd 14.8)
Range 81 – 124 µ
Ratio Intended/Achieved (I/A): 1.06
10. LASIK Results Flap Diameter > 9 mm
Ratio I/A: 1.28
HINGE: Ratio I/A: 1.42
11. LASIK Results FLAP DECENTRATION: 1 Case (1.2 mm)
IRREGULARITIES OF THE EDGE: None
FLAP STRIAE: 3 cases with micro-striate during the first 7 days not requiring repair
12. RESULTS: Epi-LASIK DIAMETER
8.7 mm (sd 0.3)
Range 8.2 – 9,3 mm
Defined edges: 100% cases
Decentration
2 cases (enlarged manually without problems)
13. RESULTS: PRK Manual epithelial removal
Diameter Adjusted
Irregular edges: 80%
Trans-epithelial laser removal
Diameter Adjusted
Irregular edges: 40%
19. Epi-LASIK surgical procedure with Epi-KTM
20. Why Epi-LASIK procedure ? 1. Faster healing than PRK
2. Faster visual recovery: “WOW” factor
3. Treatment of a wider range of patients
4. Differentiate yourself !
21. Faster healing
22. Faster visual recovery
23. Better visual acuity
24. Faster visual recovery
25. Faster visual recovery
26. Faster visual recovery than PRK
27. The 5-minute Epi “Wow” factor “At 5 minutes:
Most patients see 20/40 or better.
Many see 20/20 or better.”
28. With Epi-LASIK you can treat an additional range of patients:
who do not accept post-op pain
who want faster visual recovery than LASEK or PRK
who view PRK/LASEK as an old-fashioned procedure
who are looking for the latest technology available
Epi-LASIK allows to ask for premium prices
Epi-LASIK allows to:
Differentiate yourself from centers doing PRK or LASEK
29. Epi-LASIK: with or without the flap ? Both techniques give good outcomes
Most surgeons today are discarding the flap
30. Safety and design features:
Metal separator
Applanation plate
Variable speed
Disposable plastic head with integrated cleaver Why the Moria Epi-KTM ?
31. Why Epi-LASIK over LASIK? The trend is to go back to the surface
To minimize the risk of ectasia
To treat a wider range of patients
Visual outcomes: similar or superior to the femtosecond technology
33. Why this return to the surface?
Patients requests
The post-LASIK risks of ectasia
34. To minimize the risks of ectasia Lower risk of ectasia than with PRK
Corneal biomechanics is not compromised like in LASIK
Post-LASIK cases of ectasia are more and more reported and published:
35. Patients looking for safety first
Patients with dry eye syndrome
Patients with thin corneas (<500 microns)
Patients that have active life styles or occupations where flap dislodgement is a possibility
Patients who don’t want their eyes cut and that have been turned off by the pain and long visual recovery of PRK/LASEK
36. Thank you for your attention