SPS-109 Keratorefractive Complications | ASCRS
2020 ASCRS Virtual Annual Meeting

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Papers in this Session
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Control of Signal of Suction Loss during SMILE Surgery
Author
Ji Bai, MD, CAE

Purpose
To analyze the influencing factors for the stable of cones, and to investigate its prevention suction loss strategy during SMILE surgery

Methods
In this retrospective study using operation video, the indications of signal of suction loss characteristics were recorded. The volunteers simulated the direction and degree of eye and head movement when the feature of "loss of suction" appeared in the process of centration with the cone. The effect of indication of suction loss was observed using corresponding intervention strategies. We compared the incidence of suction loss between the intervention group and the control group (20 eyes each) after the occurrence of indication of suction loss

Results
The indication characteristics of signal of suction loss. A total of 50 eyes were observed, 96% cases of which were located in the upper part (including superior temporal and nasal) and 4% in the lower part. When the volunteers simulated loss of suction by moving mandible down and forehead up, the superior loss of suction 100% appeared. The contrary movement induced contrary loss of suction. Indication suction loss could be terminated when the movement stopped. Actual suction loss occurred in 6 eyes when there was no intervention for indication signal of suction loss, while there was no actual suction loss when intervention was performed (head fixed).

Conclusion
Suction loss in SMILE is often related to intraoperative eye and head movement (mainly mandibular movement) of patients. Correct deal with can effectively prevent the occurrence of loss of suction
Topography-Guided Photorefractive Keratectomy for Correction of Irregular Astigmatism Following Penetrating Keratoplasty. (No Audio)
Authors
Mukhtar Bizrah, MBBS, FRCOphth
David TC. Lin, MD, FRCS
Simon P. Holland, MD, FRCS
Shwetabh Verma, MSc

Purpose
Post-keratoplasty eyes frequently have high and irregular astigmatism difficult to correct with rigid contact lenses possibly needing further surgery. We aimed to evaluate the alternative of topography-guided Photorefractive Keratectomy (TG-PRK) for correction of irregular astigmatism following penetrating keratoplasty (PK) using Schwind Amaris

Methods
Retrospective, non-randomized, consecutive series of contact lens intolerant eyes with irregular astigmatism following PK that underwent trans-epithelial (TE) TG-PRK with the Schwind Amaris 1050 SmartSurfACE Excimer Laser. Eyes with at least 12 months of follow-up were included. Data collected included pre-operative and post-operative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), topographic cylinder and the number of Snellen lines gained or lost. Any complications were recorded.

Results
45 eyes had sufficient data at 12 months for analysis. 16/45 eyes (36%) showed UDVA ≥20/40 post-operatively with none pre-operatively. 21 eyes (46%) had improved CDVA with 15 eyes (33%) gained ≥2 lines. 5 eyes (11%) lost ≥2 lines. Mean pre-operative topographic cylinder was 5.58±2.84D. Reduction in astigmatism (RIA) was 2.36±2.38D. Mean spherical equivalent improved from -3.00±3.93D to -1.50±2.18D. No patient showed regression up to 12 months post-operatively. There were no eyes with visually significant haze and no infection post-operatively. Five eyes had delayed epithelial healing without long term sequelae.

Conclusion
TE TG-PRK showed satisfactory efficacy and safety for treatment of irregular astigmatism following corneal transplantation. More than one third achieved ≥20/40 UDVA postoperatively but none before surgery. TG-PRK maybe a good alternative to astigmatic keratotomy and wedge resection for contact lens intolerant post keratoplasty patients.
Topography-Guided Photorefractive Keratectomy for Irregular Astigmatism after Radial Keratotomy Using a High-Speed Laser ( No Audio)
Authors
Simon P. Holland, MD, FRCS
David TC. Lin, MD, FRCS
Mukhtar Bizrah, MBBS, FRCOphth
Shwetabh Verma, MSc

Purpose
Evaluation of Topography-guided Photorefractive Keratectomy (TG-PRK) for Irregular astigmatism after Radial Keratotomy (RK) with Schwind Amaris 1050 (SA).

Methods
Retrospective case series of 33 RK eyes treated with SA laser and CXL. Data collected at 12 months for analysis: pre- and post-operative UDVA, CDVA, MR and topographic cylinder.

Results
19 of 33 (58%) showed UCVA ≥20/40 post-operatively. 17 (52%) had improved CDVA and 9(27%) gained ≥2 lines while 1 (3%) lost 2 or more line. Mean astigmatism was reduced from 2.07±1.79D to 0.98±1.17D. Mean spherical equivalent was improved from 2.46±1.95D to -0.42±1.79D.

Conclusion
Early results of TG-PRK CXL with Schwind Amaris 1050 show efficacy and safety in treating post-RK irregular astigmatism. More than a half (58%) had UDVA ≥20/40 at one year and 25% had CDVA improved ≥2 lines. The technique maybe an alternative treatment for post-RK with contact lens intolerance.
Causes of Explantation of Iris-Fixated Phakic Intraocular Lenses.
Authors
Fiorella Casanova, MD
Luis Izquierdo, MD, PhD
Or Ben-Shaul, MD
Maria A. Henriquez, MD, PhD

Purpose
To describe the causes of extraction of iris fixated phakic intraocular lenses (pIOLs) Artisan-Artiflex.

Methods
In this retrospective single center study, we reviewed 253 eyes of 176 patients underwent pIOLs (Artisan-Artiflex) implantation at Instituto de Ojos Oftalmosalud from 2001 to 2019. The parameters evaluated were percentage of lens extractions, differentiated by causes and the pIOL survival time. Anterior chamber morphometrics were also analyzed retrospectively as well as other parameters (age, sex, endothelial cell count, peripheral endothelial-lens distance, pIOL power and model).

Results
A total of 35 pIOLs had to be explanted (13.8%) after a mean of 12.18 +/-3.9 (SD) years. Cataract formation was the main cause of extraction in 62.9% (22) of the cases. Corneal transplant, because of corneal decompensation, was needed in 28.6% (10) of the cases. High intraocular pressure alone was the cause of extraction in 2.86% (1). The mean distance between the peripheral edge of the pIOL and the endothelium in eyes without pIOL extraction was 1.41mm (SD+/-0.27); a significant smaller distance was found in eyes with pIOL extraction 1.12mm (+/-0.35) (P < 0.001), and in eyes with pIOL extraction and corneal decompensation that required a corneal transplant 0.77mm (+/-0.41).

Conclusion
The mean survival time of the pIOLs was 12.18 +/- 3.9 years. ECL was present in almost all of the cases of extraction. Cataract formation was the main cause followed by corneal decompensation. We believe a small E-L (endothelial-lens) distance could be a good predictor of ECL and corneal decompensation.

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