mr. dan gore presentation at the mediphacos user meeting 2013
DESCRIPTION
KeraRings - New clinical pathways in keratoconusTRANSCRIPT
KeraRings - New clinical pathways in keratoconus
Dan GoreBruce Allan
At diagnosis…
Refractive correction pIOLFine shape correction PRK(≥2 years post CXL)
Gross shape correction ICRS (CDVA <20/20, coma >3µm)
CDVA poor (rigid contact lens dependent)
CDVA good(spectacle dependent)
Shape stabilisation CXL
UDVA good(spectacle independent)
Gore DM, Shortt AJ, Allan BD Eye 2013;27:329-39
KeraRing patients
• 17 eyes of 17 patients• Femtosecond laser channels• 16 keratoconus, 1 post-LASIK ectasia– Age 32 (range 25-47)– Refractive astigmatism 7.88D– UDVA < 20/200– CDVA 20/40
• Follow-up 20 months (range 14-25)
20/1200
20/600
20/480
20/400
20/360
20/200
20/12020/40
20/300
1
2
Uncorrected distance VA (n=10)N
umbe
r of e
yes
20/12020/80
20/6020/40
20/30 20/20
0
4
8
12 Corrected distance VAPre-opPost-op
Num
ber o
f eye
s
p=0.018
p<.001
Change in visual acuity
Coma: Pre-op -4.20µm Post-op -2.75µm (p<.001)
No change
Gain 1 line
Gain 2 lines
Gain 3 line
Gain 4 lines
Gain 5 lines
Gain > 5 lines
0
2
4
6
8
10
12
CDVA
UDVA
Num
ber o
f eye
s
<1
1.01 - 2.00
2.01 - 3.00
3.01 - 4.00
4.01 - 5.00
5.01 - 6.00
6.01 - 7.00
7.01 - 8.00
8.01 - 9.00
9.01 - 10.00
>100
2
4
6
Refractive astigmatismPre-opPost-op
Num
ber o
f eye
s
-8 -6 -4 -2 0 2 4 6
-14
-10
-6
-2
2
6Δ spherical equivalent
Post-op (D)
Pre-
op (D
)
-7.88-4.18
p <.001
Pre -3.62DPost -1.85D
0 2 4 6 80
2
4
6
8Corneal astigmatism (K2-K1)
Pre-op corneal astigmastim (D)Post
-op
corn
eal a
stigm
a-tis
m (D
)
-10-8-6-4-202468 Δ Kmax
Kera
tom
etry
(D)
KmeanPre 49.8DPost 48.6D
• Previously RGP intolerant• Now comfortable in toric SCL• PK/DALK avoided
-1.00/-4.25 x 60 CDVA 20/120
6.00/ -2.00 x 130 CDVA 20/20
Post-op Pre-op
Summary outcomes
• 4 patients progressed = CXL
• 16/18 (89%) pleased with outcome– Central striae, CDVA 6/9, elective DALK– CDVA 20/20 pre & post, cylinder reduced by 6D– 5 patients in toric SCLs previously intolerant of RGPs