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6 Month Results of a Wavefront-Topography-Supported Custom Ablation: MEL80 CRS-Master II Dan Z Reinstein MD MA(Cantab) FRC...
MEL80: CRS-Master II Target Surface starts at “lowest” point of the irregularities Irregular Surface Target Toric Surface
Principles of CRS-Master II <ul><li>Combination: </li></ul><ul><ul><ul><li>Manifest refraction  </li></ul></ul></ul><ul><u...
MEL80: CRS-Master II Refraction: +0.75 -1.50 x 170° Refraction treated <ul><li>Topography algorithm measures the refractio...
Non-Linear Aspheric Profile <ul><li>CRS Master proprietary energy correction algorithm </li></ul><ul><li>Reduce induction ...
Study: Patients <ul><li>48 eyes from 32 patients </li></ul><ul><li>Patient Complaints </li></ul><ul><ul><li>Severe Night V...
Procedures <ul><li>Primary Procedures </li></ul><ul><li>LASIK 16 eyes </li></ul><ul><li>PRK 14 eyes </li></ul><ul><li>CK 4...
Outcome Measures <ul><li>Efficacy </li></ul><ul><li>Accuracy </li></ul><ul><li>Safety </li></ul><ul><li>Contrast Sensitivi...
Example: Zone Expansion Pre Op UCVA 20/20 Rx: +0.75 -0.50 x 11 (20/20) Post Op – 6 Months Post PRK UCVA 20/63 Rx: +1.50 -0...
Example: Decentration Pre Op UCVA  20/20 Rx: +0.25 -0.25 x 33 (20/20) Post Op – 6 Months Post PRK UCVA  20/16 Rx: +0.50 -0...
Example: Decentration Pre Op UCVA  20/100 Rx: -1.88 -0.75 x 28 (20/20) Post Op – 4 Days Post PRK UCVA  20/32 Rx: -0.25 -0....
Example: High Myopia Deep Lamellar Transplant Pre Op UCVA 20/4000 Rx: -8.50 -4.00 x 73 (20/40) Post Op – 3 Months Post PRK...
Example: High Myopia Deep Lamellar Transplant Pre Op UCVA 20/400 Rx: +3.50 -7.75 x 70 (20/50) Post Op – 2 Weeks Post LASIK...
Example: High Myopia Deep Lamellar Transplant Pre Op UCVA 20/400 Rx: -2.25 -4.75 x 19 (20/32) Post Op – 6 Months Post LASI...
Example: Decentration Following RK Pre Op UCVA 20/40 Rx: +1.50 -1.50 x 111 (20/20) Post Op – 4 months Post PRK UCVA 20/16 ...
Example: Decentration Following RK Pre Op UCVA 20/50 Rx: +3.50 -2.25 x 165 (20/50) Post Op – 6 months Post PRK UCVA 20/50 ...
Safety: Best Corrected Visual Acuity
Safety: Best Corrected Visual Acuity
Efficacy: Uncorrected Visual Acuity
Attempted vs Achieved Spherical Equivalent Transplant +3.50 -7.75 x 70 Transplant -2.25 -4.75 x 19
Accuracy: Within Range of Intended
Higher Order RMS – All Eyes
Spherical Aberration (Seidel) – All Eyes
Contrast Sensitivity All Eyes Eyes with below normal contrast
Conclusions <ul><li>Combined Topography/Wavefront </li></ul><ul><ul><li>Regularised the cornea </li></ul></ul><ul><ul><ul>...
6 Month Results of a Wavefront-Topography-Supported Custom Ablation: MEL80 CRS-Master II Dan Z Reinstein MD MA(Cantab) FRC...
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6 Month Results of Topography Guided Repair

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6 Month Results of Topography Guided Repair

  1. 1. 6 Month Results of a Wavefront-Topography-Supported Custom Ablation: MEL80 CRS-Master II Dan Z Reinstein MD MA(Cantab) FRCSC 1,2,3,4 Timothy J Archer, MA(Oxon), DipCompSci(Cantab) 1 1. London Vision Clinic, London, UK 2. St. Thomas’ Hospital - Kings College, London, UK 3. Weill Medical College of Cornell University, New York, USA 4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France
  2. 2. MEL80: CRS-Master II Target Surface starts at “lowest” point of the irregularities Irregular Surface Target Toric Surface
  3. 3. Principles of CRS-Master II <ul><li>Combination: </li></ul><ul><ul><ul><li>Manifest refraction </li></ul></ul></ul><ul><ul><ul><li>Topography/Topographic Wavefront </li></ul></ul></ul><ul><ul><ul><li>Internal ocular optics </li></ul></ul></ul><ul><li>Result: Ideal postoperative surface </li></ul><ul><ul><ul><li>Accurate postoperative refraction. </li></ul></ul></ul><ul><li>First system in the world to do this. </li></ul>
  4. 4. MEL80: CRS-Master II Refraction: +0.75 -1.50 x 170° Refraction treated <ul><li>Topography algorithm measures the refraction </li></ul><ul><li>Target elevation is a toric surface with this refraction </li></ul>
  5. 5. Non-Linear Aspheric Profile <ul><li>CRS Master proprietary energy correction algorithm </li></ul><ul><li>Reduce induction of spherical aberration </li></ul><ul><li>Improve effective ablation for irregular profiles </li></ul>VHF digital ultrasound
  6. 6. Study: Patients <ul><li>48 eyes from 32 patients </li></ul><ul><li>Patient Complaints </li></ul><ul><ul><li>Severe Night Vision Disturbances </li></ul></ul><ul><li>Clinical Diagnoses – Atlas Topography </li></ul><ul><ul><li>Small optical zone </li></ul></ul><ul><ul><li>Decentred ablation </li></ul></ul><ul><ul><li>Irregular Surface </li></ul></ul><ul><li>Wavefront exams showing increased aberrations </li></ul><ul><li>Artemis VHF digital ultrasound RST </li></ul>
  7. 7. Procedures <ul><li>Primary Procedures </li></ul><ul><li>LASIK 16 eyes </li></ul><ul><li>PRK 14 eyes </li></ul><ul><li>CK 4 eyes </li></ul><ul><li>RK 4 eyes </li></ul><ul><li>Deep lamellar transplant 7 eyes </li></ul><ul><li>Central corneal scar 1 eye </li></ul><ul><li>Wound gape following cataract surgery 2 eyes </li></ul><ul><li>Repair Procedures </li></ul><ul><li>LASIK 3 eyes </li></ul><ul><li>LASIK flap lift 12 eyes </li></ul><ul><li>PRK 33 eyes </li></ul>
  8. 8. Outcome Measures <ul><li>Efficacy </li></ul><ul><li>Accuracy </li></ul><ul><li>Safety </li></ul><ul><li>Contrast Sensitivity </li></ul><ul><li>Topography Change </li></ul><ul><li>Higher Order Aberrations </li></ul><ul><li>Follow-up: median 9.4 mths (at least 3 mths) </li></ul>
  9. 9. Example: Zone Expansion Pre Op UCVA 20/20 Rx: +0.75 -0.50 x 11 (20/20) Post Op – 6 Months Post PRK UCVA 20/63 Rx: +1.50 -0.50 x 141 (20/20) Ablation Pattern Topography Difference 8 out of 10 Coma 0.73 µm Sph Ab -8.38 µm HO RMS 0.64 µm Coma 5.30 µm Sph Ab -15.84 µm HO RMS 1.26 µm
  10. 10. Example: Decentration Pre Op UCVA 20/20 Rx: +0.25 -0.25 x 33 (20/20) Post Op – 6 Months Post PRK UCVA 20/16 Rx: +0.50 -0.75 x 62 (20/16) Ablation Pattern Topography Difference 8 out of 10 Coma 2.81 µm Sph Ab -3.15 µm HO RMS 0.50 µm Coma 4.49 µm Sph Ab -7.71 µm HO RMS 0.88 µm
  11. 11. Example: Decentration Pre Op UCVA 20/100 Rx: -1.88 -0.75 x 28 (20/20) Post Op – 4 Days Post PRK UCVA 20/32 Rx: -0.25 -0.25 x 105 (20/32) Ablation Pattern Topography Difference 8 out of 10 No WASCA post op yet Coma µm Sph Ab µm HO RMS µm Coma 3.61 µm Sph Ab -13.17 µm HO RMS 1.00 µm
  12. 12. Example: High Myopia Deep Lamellar Transplant Pre Op UCVA 20/4000 Rx: -8.50 -4.00 x 73 (20/40) Post Op – 3 Months Post PRK UCVA 20/40 Rx: 0.00 -1.25 x 130 (20/32) Ablation Pattern Topography Difference 10 out of 10 Coma 2.81 µm Sph Ab -5.96 µm HO RMS 0.70 µm Coma 1.24 µm Sph Ab -5.61 µm HO RMS 0.92 µm
  13. 13. Example: High Myopia Deep Lamellar Transplant Pre Op UCVA 20/400 Rx: +3.50 -7.75 x 70 (20/50) Post Op – 2 Weeks Post LASIK UCVA 20/63 Rx: -0.50 -2.25 x 20 (20/32) Ablation Pattern Topography Difference 9 out of 10 5mm Coma 1.56 µm Sph Ab 3.65 µm HO RMS 0.68 µm Coma 2.15 µm Sph Ab -0.18 µm HO RMS 0.59 µm
  14. 14. Example: High Myopia Deep Lamellar Transplant Pre Op UCVA 20/400 Rx: -2.25 -4.75 x 19 (20/32) Post Op – 6 Months Post LASIK UCVA 20/32 Rx: -1.00 sph (20/32) Ablation Pattern Topography Difference 9 out of 10 5mm Coma 5.43 µm Sph Ab -3.23 µm HO RMS 0.72 µm Coma 2.86 µm Sph Ab -2.20 µm HO RMS 0.63 µm
  15. 15. Example: Decentration Following RK Pre Op UCVA 20/40 Rx: +1.50 -1.50 x 111 (20/20) Post Op – 4 months Post PRK UCVA 20/16 Rx: +0.25 -1.25 x 120 (20/16) Ablation Pattern Topography Difference 7 out of 10 Coma 2.97 µm Sph Ab -3.69 µm HO RMS 0.48 µm Coma 2.02 µm Sph Ab -11.81 µm HO RMS 0.92 µm
  16. 16. Example: Decentration Following RK Pre Op UCVA 20/50 Rx: +3.50 -2.25 x 165 (20/50) Post Op – 6 months Post PRK UCVA 20/50 Rx: +3.00 -2.75 x 45 (20/40) Ablation Pattern Topography Difference Coma 3.88 µm Sph Ab -1.40 µm HO RMS 0.57 µm Coma 2.82 µm Sph Ab -12.04 µm HO RMS 1.16 µm
  17. 17. Safety: Best Corrected Visual Acuity
  18. 18. Safety: Best Corrected Visual Acuity
  19. 19. Efficacy: Uncorrected Visual Acuity
  20. 20. Attempted vs Achieved Spherical Equivalent Transplant +3.50 -7.75 x 70 Transplant -2.25 -4.75 x 19
  21. 21. Accuracy: Within Range of Intended
  22. 22. Higher Order RMS – All Eyes
  23. 23. Spherical Aberration (Seidel) – All Eyes
  24. 24. Contrast Sensitivity All Eyes Eyes with below normal contrast
  25. 25. Conclusions <ul><li>Combined Topography/Wavefront </li></ul><ul><ul><li>Regularised the cornea </li></ul></ul><ul><ul><ul><li>Decentration </li></ul></ul></ul><ul><ul><ul><li>Zone expansion </li></ul></ul></ul><ul><ul><ul><li>Irregular cornea </li></ul></ul></ul><ul><ul><li>Accurate: 80% within ±1.00 D </li></ul></ul><ul><ul><li>Safe: no eyes lost 2 lines, 31% gain 1 line BSCVA </li></ul></ul><ul><ul><li>Reduced Spherical Aberration </li></ul></ul><ul><ul><li>Reduced HO RMS </li></ul></ul><ul><ul><li>Improved contrast sensitivity, particularly for eyes with below contrast pre-op </li></ul></ul>
  26. 26. 6 Month Results of a Wavefront-Topography-Supported Custom Ablation: MEL80 CRS-Master II Dan Z Reinstein MD MA(Cantab) FRCSC 1,2,3,4 Timothy J Archer, MA(Oxon), DipCompSci(Cantab) 1 1. London Vision Clinic, London, UK 2. St. Thomas’ Hospital - Kings College, London, UK 3. Weill Medical College of Cornell University, New York, USA 4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche) , Paris, France Thank You

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