Laser Thermal Laser Thermal Keratoplasty in Keratoplasty in Patients with Patients with Hyperopia of Hyperopia of

Presbyopic AgePresbyopic Age

Alexander V. Doga, Alexander V. Doga, MD, PhD, DSc,MD, PhD, DSc, Alexander A. Shpak, MD, PhD, DSc,Alexander A. Shpak, MD, PhD, DSc,

Irina A. Mushkova, MD, PhD,Irina A. Mushkova, MD, PhD,Suzy A. Antonian, MD Suzy A. Antonian, MD

The S.N. Fyodorov Eye Microsurgery Federal State Institution The S.N. Fyodorov Eye Microsurgery Federal State Institution Moscow, Russian FederationMoscow, Russian Federation

PurposePurpose – – to assess the long-term efficacy and to assess the long-term efficacy and

safety safety of LTK for hyperopia correction of LTK for hyperopia correction

in patients of presbyopic agein patients of presbyopic age MethodsMethods

Laser deviceLaser device «ОКО-1»«ОКО-1» (Russia)(Russia)

infrared Ho:YAGinfrared Ho:YAG laserlaser wavelength wavelength : : 22..1212 micronsmicrons Е: Е: 130 – 180130 – 180 mJmJ irradiation periodirradiation period – – 00..55 secsec..

SubjectsSubjects

Accommodative Accommodative amplitudeamplitude: : 0,75 - 1,5 0,75 - 1,5 DD

(mean 1,24±0,27 D)27 27 patientspatients(54 (54 eyeseyes))

I group II group

25 25 patientspatients(50 (50 eyeseyes))

Target refractionTarget refraction: : low Mlow M Target refractionTarget refraction:: EmEm

Accommodative Accommodative amplitudeamplitude: : 1,75 - 2,75 1,75 - 2,75 DD

(mean 2,01±0,29 D)

• Age: 43-61years

• SE of refraction: 1,0-3,5 D (mean 2,16±0,97 D )

• Age : 41-58 years

• SE of refraction: 1,25-3,0 D (mean 2,26±0,81 D )

Schematic view of the operation

Surgical procedure

Double-ring checkerboard pattern of 24

coagulation spots

Laser energy:Laser energy:I groupI group:: ЕЕ 160-180160-180 mJ mJII groupII group:: ЕЕ 130-150 130-150 mJmJ

ResultsResults

1 day 3 days Stretch lines

6 months 3 years

Dynamics of refractionDynamics of refraction

-4

-3

-2

-1

0

1

2

3

pre-op 1 week 1 month 3months

6months

1 year 3 years

Follow-up period

Sp

he

ric

al

Eq

uiv

ale

nt

of

Re

fra

cti

on

, D I group

II group

Dynamics of uncorrected visual Dynamics of uncorrected visual acuityacuityDistance

Near

ResultsResults Group 1:Group 1:

* uncorrected distance VA did not change * uncorrected distance VA did not change significantlysignificantly

* uncorrected near VA improved by 5 lines* uncorrected near VA improved by 5 lines Group 2:Group 2:

* uncorrected distance VA improved by 4 * uncorrected distance VA improved by 4 lineslines

* uncorrected near VA improved by 2 lines* uncorrected near VA improved by 2 lines

* the presbyopic correction was reduced * the presbyopic correction was reduced from from +3.71±1.07 +3.71±1.07 to +1to +1.86±0.67 .86±0.67

Presbyopic correction significantly reduced !!

No asthenopic symptoms in the two groups post-opNo asthenopic symptoms in the two groups post-op!!

II group

For nearFor near vision:

15% of patients

For far For far vision:26% of patients

Pre-op – glasses for near vision:

100% of the patients

Pre-op – glasses for far vision:

87% of the patients

Spectacle correctionSpectacle correction

I group

Post-opPost-op Post-opPost-op

For nearFor near vision:

100% of patients

For far For far vision:0% of patients

ConclusionsConclusions

1.1. Hyperopia correction in Hyperopia correction in patients of presbyopic age by patients of presbyopic age by contact holmium:YAG LTK is contact holmium:YAG LTK is safe and effective.safe and effective.

2.2. Pre-op level of amplitude of Pre-op level of amplitude of accommodationaccommodation provides provides important data for better important data for better planning of the operation in planning of the operation in presbyopic patients.presbyopic patients.