lasik xtra - the light for sight foundation · lasik xtra: restoring corneal strength creation of...
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LASIKXTRA:WHATDOESTHELITERATURESHOW?
LasikXtra:Restoringcornealstrength
CreationoftheLASIKflapweakensthecorneabyasmuchas30%.LasikXtratreatmentprotocolsaredesignedtoapplysufficientstiffeningtorestorethecornea
toitspre-LASIKlevelofstiffness,withoutexcessivechange
LasikXtra:CornealstrengtheningduringLASIK
ThegoalofLasikXtraistorestorebiomechanicalintegritytocorneasthathavebeenweakenedbyrefractivesurgerytoachievestable,predictablevisualoutcomesinorderto:
• Reducetheriskofpost-LASIKrefractiveregression• Reducetheriskofpost-LASIKectasia
Riboflavinisrinsedfromtheeye,andtheflapisrepositionedasusual
TheLASIKflapisleftopenfollowingexcimerlaserablation
Dextranfreeriboflavinisappliedtothestromalbedimmediatelyafterablation
UVAilluminationisappliedthroughtheclosedflapfor90secondsat30mW/cm2
LasikXtra:CornealstrengtheningduringLASIK
LasikXtra:MaintainingPredictability
Centertoedgebeamuniformityinsuresconsistentresults
Pan-cornealtreatment• KXLsystemwithhomogenousbeamprofileand
largedepthoffocusisusedtocross-linktheentirecentral9mmofthecornea
• Uniformtreatmentacrossthelargetreatmentzonerestoresstabilitywithoutredistributingcornealstresses(noshapechange)
• Thisdiffersfromtreatmentofkeratoconus,wherethecorneahasafocalregionofweakness
LASIK+CORNEALCROSS-LINKING:KEYPOINTS
Whatdoweknow: LASIKweakensthecornea Cross-linkingsCffensthecornea
WhatDoWeNeedtoKnow? Canwesafelyaddcross-linkingtoLASIK? CanweachievepredictablerefracCveoutcomeswithLasik
Xtra? CanLasikXtraimprovecornealstability?
LasikXtra:ClinicalResults
LasikXtra:SafetyPublishedstudiesshownoendothelialcellloss
• CelikHU,AlagözN,YildirimY,etal.Acceleratedcornealcrosslinkingconcurrentwithlaserinsitukeratomileusis.JCataractRefractSurg.2012;38(8):1424–31
• KanellopoulosAJ.Long-termsafetyandefficacyfollow-upofprophylactichigherfluencecollagen
cross-linkinginhighmyopiclaser-assistedinsitukeratomileusis.ClinOphthalmol.2012;6:1125–30.• TomitaM,YoshidaY,YamamotoY,MitaM,WaringG.Invivoconfocallasermicroscopyof
morphologicchangesaftersimultaneousLASIKandacceleratedcollagencrosslinkingformyopia:One-yearresults.JCataractRefractSurg.2014;40(6):981–90.
• MazzottaC,BalestrazziA,TraversiC,CaragiuliS,CaporossiA.InvivoConfocalMicroscopyReport
afterLasikwithSequentialAcceleratedCornealCollagenCross-LinkingTreatment.CaseRepOphthalmol.2014;5(1):125–31.
• WuY,TianL,WangL,HuangY.EfficacyandSafetyofLASIKcombinedwithAcceleratedCorneal
CollagenCross-LinkingforMyopia:SixMonthStudy.BiomedResInt.2016;5083069.
LasikXtra:Safety
• Inastudyapplying9mW/cm2CXL,agreaterpost-operativeinflammatoryresponsewasseenintheLasik+CXLgroupduringthefirstpostoperativeweek.
• DLKresolvedinalleyesby1week.• NoeyesineithergrouplostCDVAat1year
post-operatively.
SuperficialcornealcrosslinkingduringlaserinsitukeratomileusisTheoG.Seiler,MD,IsaakFischinger,MD,TobiasKoller,MD,ViktorDerhartunian,MD,TheoSeiler,MD,PhDJCataractRefractSurg2015;41:2165–2170
AdjunctiveCollagenCrosslinkingoftheResidualStromalBedinLASIK:FiniteElementAnalysisofImpactonRefractiveOutcomeandSurgicallyInducedDeformation
LASIK
IOP15MMHG IOP30MMHG
PRE-OP
LASIK+Cross-linking
SevenI,RoyASR,DuppsBJ,ClevelandClinicColeEyeInstitute.ARVO;2014
LASIK15MM(microns)
LASIK+CXL15MM(microns)
LASIK30MM(microns)
LASIK+CXL30MM(microns)
1 194 183 393 371
2 206 195 419 396
3 205 194 416 394
4 270 254 547 516
P<0.05 P<0.05
RESULT:LASIKwithCXLoftheRSBemployinga50%increaseinanteriorRSBstiffnesscontributedlessthan0.25DofhyperopiceffecttothepostoperativerefractiveerrorandsignificantlyreducedcornealdisplacementsafterLASIK.
SIMULATION:-4.25DLASIKprocedure,wavefrontoptimizedablationprofilewithOZD6.5mm.CXLofthecentral9mmoftheRSBwithdepth200micronandstiffeningfactor1.5.Tangentialcurvaturesofanteriorsurfacepointswerecalculated
LasikXtra:Predictability
InvivoconfocallasermicroscopyofmorphologicchangesaftersimultaneousLASIKandacceleratedcollagencrosslinkingformyopia:One-yearresults
MinoruTomita,YukoYoshida,YusukeYamamoto,MarikoMita,GeorgeWaringIV,JCRSVol40,JUNE2014
LasikXtra:Predictability
SphericalEquivalentRefractiveAccuracyLASIKvs.LASIKXtraat3Months
JerryTan,MDEurJofOphthalmology2015
LasikXtra:Predictability
LasikXtra:PredictabilityShort-termVarianceofRefractiveOutcomesAfterSimultaneousLASIKandHigh-FluenceCross-linkinginHighMyopicCorrectionTommyC.Y.Chan,FRCS;MarcoC.Y.Yu,PhD;et.al.JRefractSurg.2016;32(10):664-670WhilethepreviousstudiesofLasikXtraconductedwith30mW/cm2irradiance(KXL)showequivalentorbetterpredictabilitythanLASIKalone,thisstudyconductedusing18mW/cm2irradiance(CXL-Vario)demonstratedbetterpredictabilityintheLASIK-onlygroupthanintheLasik+CXLgroup.
InvivoconfocallasermicroscopyofmorphologicchangesaftersimultaneousLASIKandacceleratedcollagencrosslinkingformyopia:One-yearresultsMinoruTomita,MD,PhD,YukoYoshida,BA,YusukeYamamoto,MD,MarikoMita,MD,PhD,GeorgeWaringIV,MD.JCATARACTREFRACTSURG-VOL40,JUNE2014
LasikXtra:Stability
Comparisonofprophylactichigherfluencecornealcross-linkingtocontrol,inmyopicLASIK,oneyearresults.KanellopoulosAJ,AsimellisG,KarabatsasC.ClinOphthalmol.2014Nov27;8:2373-81
LasikXtra:Stability
Topography-guidedHyperopicLASIKWithandWithoutHighIrradianceCollagenCross-linking:InitialComparativeClinicalFindingsinaContralateralEyeStudyof34ConsecutivePatients.KanellopoulosAJ,AsimellisGJournalofRefractiveSurgery2012
AdjuvantcornealcrosslinkingtopreventhyperopicLASIKregression.AslanidesIM,MukherjeeAN.Clin.Ophthalmol.2013
LasikXtra:Stability
• Hyper-reflectivityandkeratocyteapoptosistoastromaldepthof150-160µm
• Keratocyterepopulationcompleteby6monthspostoperatively
• Noendothelialdamagewasobserved
• Findingssuggestmicrostructuralchangessimilartothosefoundwithconventionalcross-linking
MazzottaC,BalestrazziaA,TraversiaC,CaragiuliaS,CaporossibACaseRepOphthalmol2014;5:125–
131
ConfocalMicroscopy
LasikXtra:ReviewAr0cles
LASIK+CORNEALCROSS-LINKING:LASIKXTRAKEYPOINTS
Whatdoweknow: LASIKweakensthecornea Cross-linkingsCffensthecornea
WhatDoWeNeedtoKnow? Canwesafelyaddcross-linkingtoLASIK? CanweachievepredictablerefracCveoutcomes
withLasikXtra? CanLasikXtraimprovecornealstability?
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