dimitrios g. kyroudis medical director piraeus laser...
TRANSCRIPT
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Dimitrios G. Kyroudis
Medical Director
PIRAEUS LASER EYE CENTRE
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Alcon WaveLight® Oculyzer II Diagnostic Device
PENTACAM(Oculus)
Rotating Scheimpflug camera
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3-D modeling and analysis
of the anterior segment
Anterior corneal surface (ACS) elevation data
Posterior corneal surface (PCS) elevation data
Corneal pachymetry
Anterior chamber depth (ACD)
Lens thickness
AC IOL positioning data
Pupillometry
Opacities densitometry
Corneal Wavefront Zernicke & Fourier Analyses
Holladay report and Holladay EKR Detail Report
Belin /Ambrosio Enhanced Ectasia Display
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The Scheimpflug principle
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Preparation of data acquisition(Alignment focusing and identification
of the corneal apex as the reference point and the centre of the rotational scanning)
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PENTACAM rotating Scheimpflug camera
data acquisition
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Scheimpflug image(sagittal plane)
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Calculated 3-D model
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PENTACAM 4 MAPS REFRACTIVE
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PENTACAM data acquisition specifications
ModelPENTACAM,
Oculyzer
PENTACAM
HR
Number of Scheimpflug images 50 100
Data points per surface 25000 138000
Points per scan (max) 500 1380
Distance between points on a single scan ≈20µm ≈ 7µm
Maximum distance between 2 adjacent
scans≈160µm ≈320µm
Acquisition time 2sec
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Intacs for keratoconus
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Flap visualisation and measurement of Residual Bed Thickness
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Posterior capsule opacification
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Cataract
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Keratoconus
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Basic curve necessity
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Elevation data
Reference shape
(Best fit sphere)
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Best fit sphere calculation
Fit zone
Best fit sphere
Cornea
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What constitutes
normal or abnormal elevation?
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9mm 10mm
11mm 12mm
Normal values are set for a specific fit zone
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Elevation values for 8mm fit
Belin-Ambrosio
N=100
Anterior Apex
(μm)
Anterior
Thinnest (μm)
Posterior Apex
(μm)
Posterior
Thinnest (μm)
Average (±SD) 1.62±1.32 1.65±2.02 0.81±2.99 3.58±4.70
Range -5 to 4 -5 to 6 -6 to 6 -6 to 18
2SD/3SD 4.26/5.58 5.69/7.71 6.79/9.78 12.98/17.68
5% of the
population
(suspicious)
>4μm >6μm >7μm >13 μm
0.5% of the
population
(abnormal)
>6 μm >8 μm >10 μm >18 μm
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TOPOGRAPHIC CRITERIA(Pentacam)
Anterior elevation >12-15μm Posterior elevation >20μm
(In astigmatic corneas the toric fit is assessed)Bow-tie assymetry >1,5DPosterior curvature >7DPentacam keratoconus screening & indicesKeratometric power deviation >1,8DPachymetry <500μm
…THEN PRK
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The standard indices
The Belin Ambrosio Display (BAD II)
The Holladay Report
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The standard indices
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The Belin Ambrosio Display (BAD)
The standard BFS averages
all points of the surface
The enhanced BFS excludes
4mm around the thinnest point
thus making more prominent
the abnormal elevation
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The Belin Ambrosio Display (BAD)
Enhanced BFS
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The Belin Ambrosio Display (BAD)
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The Belin Ambrosio Display (BAD II)
98% sensitivity detecting keratoconus
Not validated for corneas susceptible for keratectasia
(forme fruste, subclinical keratoconus)
8mm data can miss PMD changes
Does not pronounce cones
hidden in astigmatic surfaces
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The Holladay Report
Tangential Curvature Map
Relative Pachymetry Map
Toric Ellipsoid Fit
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The Holladay Report
Tangential nipple >48D
Posterior elevation on Toric Ellipsoid Fit >15μm
Relative Pachymetry >3.0%
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The Holladay Report
Better for detecting cones on astigmatic corneas
Not validated
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ΤΨΗΛΗΟΠΙΘΙΑ
ΚΑΜΠΛΤΛΟΣΗΣΑ
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ΤΨΗΛΗΟΠΙΘΙΑ ΑΝΤΨΩΗ
ΚΡΟΣΑΦΙΚΑ
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ΤΨΗΛΗΟΠΙΘΙΑ
ΑΝΤΨΩΗ
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ΤΨΗΛΟΑΣΙΓΜΑΣΙΜΟ
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ΤΨΗΛΗΠΡΟΘΙΑ & ΟΠΙΘΙΑ
ΑΝΤΨΩΗ(TORIC FIT)
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ΑΤΜΜΕΣΡΙΑΚΛΕΨΤΔΡΑ
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ΑΤΜΜΕΣΡΙΑΚΛΕΨΤΔΡΑ &
ΤΨΗΛΗ ΟΠΙΘΙΑΑΝΤΨΩΗ
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ΤΨΗΛΟ ΑΣΙΓΜΑΣΙΜΟ
(WTR)
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ΤΨΗΛΟΑΣΙΓΜΑΣΙΜΟ
(ATR)
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Anterior cone
(borderline)
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Holladay report
-ve
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BAD II
Anterior
+ve
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Form fruste
Keratoconus
OD
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Holladay report
+ve
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BAD II
-ve
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Form fruste
Keratoconus
OS
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Holladay report
-ve
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BAD II
borderline
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Suspicious
(asymmetry)
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Holladay report
+ve
![Page 55: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/55.jpg)
BAD II
+ve
![Page 56: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/56.jpg)
Suspicious
![Page 57: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/57.jpg)
Holladay report
-ve
![Page 58: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/58.jpg)
BAD II
borderline
![Page 59: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/59.jpg)
KK1
![Page 60: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/60.jpg)
Holladay report
+ve
![Page 61: Dimitrios G. Kyroudis Medical Director PIRAEUS LASER …static.livemedia.gr/livemedia/documents/al4459_us63_20140604091712... · Belin /Ambrosio Enhanced Ectasia Display . The Scheimpflug](https://reader030.vdocument.in/reader030/viewer/2022032614/5b494b6d7f8b9aee238be62c/html5/thumbnails/61.jpg)
BAD II
+ve