SK Kwok, MDHong Kong Laser Eye Centre, Hong Kong

The author has no financial interest in the subject matter of this e-poster

ASCRS 2011San Diego, US

Preliminary Clinical Outcomes of a Non-Invasive, Intrastromal Presbyopic

Correction in Asian Eyes

Background & Study PurposeStudy Purpose: To evaluate the preliminary clinical outcomes of INTRACOR intrastromal presbyopic correction in Asian Eyes.

ASCRS 2011, SK Kwok

•The INTRACOR procedure is performed on a femtosecond laser (TECHNOLAS Perfect Vision).•The laser forms a series of concentric rings within the stroma which causes a localised change in the biomechanical properties of the stroma.•This leads to a central steepening of the cornea.•The procedure takes 20 seconds to perform.•The procedure uses a curved Patient Interface which adapts to the natural shape of the cornea, without applanation, reducing the increase in IOP when applying suction

Note: INTRACOR is not currently approved for use in the US

Methods & MaterialsA prospective, non-comparative case series where the INTRACOR procedure wasperformed on 128 eyes of Asian patients using the TECHNOLAS Femtosecond Workstation 520F (Technolas Perfect Vision).• The non-dominant eye was treated first.

Patient Demographics:• 79 Females and 49 Males patients• Mean Age : 53 years old (range: 41 - 66)• 58 OD were treated; 70 OS were treated

Pre-operative examinations: Included distance and near vision, corneal, topography, slit lamp examination and patient satisfaction

Measured outcomes:Visual acuity (UCNVA, UCDVA, BCDVA), Refractive outcomes, patient satisfaction• Post-operative follow-up at 1D, 1W, 1M and 3M

ASCRS 2011, SK Kwok

TECHNOLAS 520F

Results: Slit lamp and topography

INTRACOR post-1-week slit lamp INTRACOR Orbscan difference map (post-1-month) •Central steepening by 2.50 – 3.00D

ASCRS 2011, SK Kwok

J1

J2

J4

J10

J6

J1+-0.08

LogMAR

0

0.1

0.2

0.4

0.7

Results: UCDVA & UCNVA

0.830.73 0.74 0.79 0.78

0.18

0.660.73 0.72

0.79

0.00

0.20

0.40

0.60

0.80

1.00

1.20

PreOp (128) D1 postop (126) D7-14 postop (96) M1 postop (68) M3 postop (20)

Visit

UCDVA UCNVA

J10

J2

ASCRS 2011, SK Kwok

PreOp (128) D1 postop (126)

D7-14 postop (96)

M1 postop (68)

M3 postop (20)

-0.50

0.00

0.50

1.00 0.94

0.04 0.02 0.120.05

Sphere over time

Visit

Diop

tre

(D)

PreOp (128) D1 postop (126)

D7-14 postop (96)

M1 postop (68)

M3 postop (20)

-0.50

-0.25

0.00

0.25

-0.36-0.32 -0.30 -0.27

-0.37

Cylinder over time

Visit

Diop

tre

(D)

Results: Refractive stability

ASCRS 2011, SK Kwok

PreOp (128) D1 postop (126) D7-14 postop (96)

M1 postop (68) M3 postop (20)-0.50

-0.25

0.00

0.25

0.50

0.75

1.000.76

-0.12 -0.13 -0.02

-0.13

MRSE over time

Visit

Diop

tre

(D)

J1

J4

J6

J9

J12

J14

Pre-op n = 128

1D n = 126

1W n = 96

1M n = 68

3M n = 20

0.89

0.250.20 0.23

0.130.00

0.20

0.40

0.60

0.80

1.00

PreOp (128) D1 postop (126) D7-14 postop (96) M1 postop (68) M3 postop (20)

LogM

AR VA

Visit

ASCRS 2011, SK Kwok

Results: UCNVA (LogMAR)

Pre-op 92% J7-J16 N=128

Post-op 1W 71% J1-J3 N=96

Post op 1M 74% J1-J3 N=68

Post-op 3M 80% J1-J3 N=20

Pre-op n = 128

1D n = 126

1W n = 96

1M n = 68

3M n = 20

0.11

0.16 0.160.13 0.13

0.00

0.04

0.08

0.12

0.16

0.20

PreOp (128) D1 postop (126) D7-14 postop (96) M1 postop (68) M3 postop (20)

LogM

AR V

A

Visit

ASCRS 2011, SK Kwok

Results: UCDVA (LogMAR)

Results: Cumulative UCNVA

ASCRS 2011, SK Kwok

Cumulative UCNVA

0% 0% 2%8%

22%

48%

35%

54%

74%

88% 91%

45%

70%

100% 100% 100%

85%80%85%

0%

20%

40%

60%

80%

100%

120%

J1 J2 J3 J5 J7 J10 J16

% o

f eye

s

Pre-Op D1 W1 M1 M3

Pre-op n = 128

1D n = 126

1W n = 96

1M n = 68

3M n = 20

Cumlative Distance BCVA

6.3%

97.7% 100.0%

2.9%0.0%

100.0% 100.0%

88.2%97.1%90.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

6/4.5 6/6 6.7.5 6/9

% o

f eye

s

Pre-Op D1 W1 M1 M3

Pre-op n = 128

1D n = 126

1W n = 96

1M n = 68

3M n = 20

Results: Cumulative BCDVA

ASCRS 2011, SK Kwok

Results: Patient Satisfaction

• Some patients could see the rings but their vision is not disturbed.

• A few patients encountered halos but the symptoms dissipated after one month.

• Most patients are happy with their enhanced quality of life without reading glasses.

ASCRS 2011, SK Kwok

Conclusion

In my opinion, the intrastromal presbyopia treatment INTRACOR is

• Non invasive so very low risk for infections

• Provides stable refractive outcome during the follow up period to-date

• Provides a significant gain in uncorrected near visual acuity

• Creates a central steepening and induces about –0.50D to –0.75D of myopia

• No weakening of cornea

• High level of patient satisfaction

• Further long-term follow-up required to confirm stability of outcomes

ASCRS 2011, SK Kwok