Sze H. Wong Emil W. Chynn, MD, MBA Maximiliano Plana, MD Emily Ceisler, MD ASCRS, May 2013 San...
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Transcript of Sze H. Wong Emil W. Chynn, MD, MBA Maximiliano Plana, MD Emily Ceisler, MD ASCRS, May 2013 San...
TREATMENT OF ADULT AMBLYOPES WITH ADVANCED
SURFACE ABLATION Sze H. Wong
Emil W. Chynn, MD, MBA
Maximiliano Plana, MD
Emily Ceisler, MD
ASCRS, May 2013San Francisco, CA
LASEK /Epi-LASIK to treat amblyopes is not FDA-approved.
PURPOSE
• Can adult strabismic and/or refractive amblyopes be safely and effectively treated with Advanced Surface Ablation (ASA)?
• Can UCVA, BCVA, functional vision be improved?
• Can strabismus be decreased?
• Retrospective review of adult amblyopes who underwent LASEK or Epi-LASEK with a VISX S4 IR excimer laser between 2006-2013
• Adjunctive treatment to prevent scarring:• Mitomycin C (MMC) 0.01% intraoperatively• Oral + Topical steroids: 1-6 mo postop• Vitamin C + UV protection: 6-12 mo postop
METHOD
STUDY POPULATION CHARACTERISTICS
n = 24 eyes
Female 54 %
Male 46 %
Age (mean ± SD; range) 31 ± 9; 22 - 52
Strabismic 4 %
Anisometropic Refractive 29 %
Isometropic Refractive 67 %
LASEK 79 %
Epi-LASEK 21 %
WaveFront 42 %
Rx Range (SE) -14 to +7.50
Preop BCVA logMAR 0.27 ± 0.23
Preop Corneal Thickness 588 ± 41 µm
Ablation Depth 99 ± 41 µm
Postop Corneal Thickness 489 ± 69 µm
RESULTS: UCVA (safety)
20/200
Postop UCVA vs Preop UCVA:• 100% had improvement in UCVA• Corneal haze: trace 29%, 1+ 4%, 2+ 4%• There was no loss of UCVA (haze = clin. insig.)
UCVALog MAR
error bar = sd
20/20
PreOp PostOp (months)
-1 0 1 2 3 4 5 6 70
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
20/2000
BCVA Preop BCVA Postop0
100
200
300
400
500
600
700
800
900
1000
RESULTS: BCVA (efficacy)
Postop vs Preop BCVA:• Mean gain of BCVA of 1.43 lines (±
1.11)• 87.5% had improved BCVA
RESULTS: SE vs BCVA change in Hyperopes
Correlation coefficient = 0.62
Postop BCVAMinusPreop BCVA(logMAR)
Spherical Equivalent
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00
-0.5
-0.45
-0.4
-0.35
-0.3
-0.25
-0.2
-0.15
-0.1
-0.05
0
Hyperopic amblyopes with lower Rx have more BCVA improvement
RESULTS
Unilateral (anisometropic) amblyopes had a greater improvement in BCVA (2.5 lines) than Bilateral (isometropic) amblyopes (1.0 line) (1-tailed p value 0.04)
RESULTS
FUNCTIONAL VISION better peripheral vision: 63%improved driving: 58%increased sports ability: 29%
STRABISMUSET preop: 20Δ postop: 8ΔUCVA preop: 20/200 postop: 20/30BCVA preop: 20/30-1 postop: 20/25Would do it again? YES!
PATIENT SATISFACTION76% would undergo the operation again if given the choice
DISCUSSIONAdult strabismic/refractive amblyopes may be safely & effectively treated with ASA
No loss of UCVA (all scarring was clinically insignificant due to adjunctive measures)
Significant gains in BCVA & functional visual improvement, with excellent patient satisfaction
Better results for unilateral refractive amblyopes and low hyperopes
Further investigation is necessary, especially in strabismic amblyopes (low n)
REFERENCES
Tychsen L. Refractive surgery for children: excimer laser, phakic intraocular lens, and clear lens extraction. Curr Opin Ophthalmol. 2008 Jul;19(4):342-8.