Early recovery after simultaneous

bilateral Photorefractive
Keratectomy for Myopia

Rami Cohen1, David Varssano2,

Deborah Schimmel3 and David Zadok4
1
Sackler School of Medicine, Tel Aviv University,2 Department of
Ophthalmology, Tel Aviv medical center and Sackler School of
Medicine, Tel Aviv University, 3 Department of Ophthalmology, Rabin
medical center, Petah Tiqua and Sackler School of Medicine, Tel Aviv
University 4 Department of Ophthalmology, Assaf Harofeh Medical
Center, Zerifin, and Sackler School of Medicine, Tel Aviv University
 The authors acknowledge no
financial interest in the subject
matter of this presentation
 Once upon a time…
• Radial Keratotomy
• Automated Lamellar Keratotomy
– Some effect
– Some predictability
– Some disasters
 Late 1980’s
• Photorefractive Keratectomy
– High precision
– Stable results
– Superior to RK, ALK
 Early 1990’s
• Photorefractive Keratectomy
– Painful
– Slow recovery
– Haze
– Regression
 Mid 1990’s
• Laser In Situ Keratomileusis
– No pain
– No time
– Simultaneous
– Wow effect
– Superior to PRK
 Early 2000’s
• Laser In Situ Keratomileusis
– Keratoectasia
– Diffuse lamellar keratitis
– Flap stability
• Back to the surface?
 Why PRK now?
• Excimer laser improvement
– Scanning small spot
– Gaussian energy distribution
– EyeGaussian
trackers
ablation profile Tophat ablation profile 1 mm
Spots
– Tissue saving algorithmOptical zone
6.5 mm
– Wider treatment zone
Cornea
(top view)

2 mm
Spots 11 mm
Diameter
 Why PRK ???
• No flaps
– No steel blade flaps
– No laser explosion flaps
• Thicker residual stromal bed
• No flap dislocation
• No striae
 Purpose
• To assess the early
visual and refractive
recovery after
simultaneous bilateral
PRK using a modern flying
small spot laser.
 Setting
• Refractive surgery facility
• Allegretto 200Hz excimer laser
(WaveLight Laser Technologie
AG, Erlangen, Germany)

ALLEGRETTO
 Method
• Prospective nonrandomized
clinical trial
• Two surgeons (DV, DZ)
• Simultaneous bilateral myopic
PRK
• Emmetropia was the goal for all
eyes
 Patient Data
• 162 consecutive myopic eyes (81
patients)
• Age
30.12 ± 7.74 (range 18 to 52 years)
• Gender
51% female, 49% male
 Patient Data
• Mean preoperative sphere
- 3.02 ± 1.57 D (range, - 0.75 to
-7.75 D)
• Mean preoperative astigmatism
-0.71 ± 0.73 D (range, 0.00 to
-3.50 D)
 Patient Data
• Contact lens history
SCL: 65%, RGPCL: 5%
• Contact lens wear duration
7.93 ± 6.90 years (range 2 months
to 32 years)
• Stopped CL use
376 ± 1148 days (1 week to 20
years; median 27 days)
 Patient Data
• IOP
13.38 ± 2.37 (range 8 to 19 mmHg)
• CCT
530.40 ± 34.62 (range 453(!) to 632
micron)
 Outcome Measures
• Main outcome measures
– uncorrected visual acuity (UCVA)
• at 1 week
• at 1 month
• Secondary outcome measures
– Manifest refraction
• at 1 week
• At 1 month after surgery
– Best corrected visual acuity at 1 month
– Haze at 1 month
– IOP at 1 month
Secondary Outcome Measures
 Results - Manifest refraction
• Manifest refraction at 1 week
– Mean sphere
0.33 ± 0.62D (range,- 1.75 to 2.75 D)
– Mean postoperative astigmatism
-0.87 ± 0.53D (range,- 2.5 to 0 D)
 Results - Manifest refraction
• Manifest refraction at 1 month
– Mean sphere
0.18 ± 0.45D (range,- 1.25 to 1.25 D)
– Mean postoperative astigmatism
-0.54 ± 0.37D (range,- 1.5 to 0 D)
 Results – Manifest Spherical Equivalents

4.00 Preoperative Week post 1 Month post 1

2.00 2.00
0.88
0.00 -0.11 -0.09
-1.00
-2.00 -2.13 -1.75
-3.38
-4.00

-6.00

-8.00 -8.25

-10.00
Results – Best corrected visual acuity at 1 month

83%
90%
80%
70% Mean BCVA = 0.98 ± 0.10
60%
50%
40%
30%
11%
20% 4%
0% 0% 2%
10%
0%
0.4 0.5 0.67 0.8 1 1.33
Results – Haze and IOP at 1 month

Haze Intra Ocular Pressure

20

18
+1
16
12% None 15.20
27% 14
13.38
12

10
Trace 8
61%
6

2
Before After
0
Primary Outcome Measures
Results - 1 week postoperative UCVA
Results - 1 month postoperative UCVA
 Conclusions
• Traditional PRK performed
utilizing a modern excimer laser
provides fast visual
rehabilitation for most patients
• The gap in speed of visual
recovery between surface
ablation and LASIK seems to
narrow
Thank you!