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Standard PRK vs. CustomVue: A Comparison of Haze. Vasudha A. Panday, Maj, USAF, MC Charles D. Reilly, Lt Col, USAF, MC, FS Wilford Hall Medical Center Lackland AFB, TX. Background. Development of haze related to depth of ablation (refractive error) - PowerPoint PPT Presentation
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Standard PRK vs. CustomVue:Standard PRK vs. CustomVue: A Comparison of Haze A Comparison of Haze
Vasudha A. Panday, Maj, USAF, MC Vasudha A. Panday, Maj, USAF, MC
Charles D. Reilly, Lt Col, USAF, MC, FSCharles D. Reilly, Lt Col, USAF, MC, FS
Wilford Hall Medical CenterWilford Hall Medical Center
Lackland AFB, TXLackland AFB, TX
BackgroundBackground
Development of haze related to depth of Development of haze related to depth of ablation (refractive error)ablation (refractive error)
Post ablation, keratocytes differentiate into Post ablation, keratocytes differentiate into myofibroblasts, cause stromal irregularitymyofibroblasts, cause stromal irregularity
Numerous factors affect myofibroblast Numerous factors affect myofibroblast transformationtransformation
PurposePurpose
To compare the incidence of haze in post-To compare the incidence of haze in post-refractive surgery patients in standard PRK refractive surgery patients in standard PRK versus wavefront guided PRKversus wavefront guided PRK
HypothesisHypothesis Wavefront-guided Wavefront-guided
ablations will cause ablations will cause less stromal less stromal irregularity, leading irregularity, leading to a decrease in to a decrease in corneal hazecorneal haze
MethodsMethods
12,551 eyes12,551 eyes Retrospective analysis of myopic treatmentsRetrospective analysis of myopic treatments 1, 3, 6, 12 months haze data1, 3, 6, 12 months haze data Haze graded on scale of 1-4Haze graded on scale of 1-4 Eyes grouped by pre-op refractions: Eyes grouped by pre-op refractions:
< 4.00 D, 4.00 – 6.00 D, and > 6.00 D< 4.00 D, 4.00 – 6.00 D, and > 6.00 D
ProcedureProcedure
Ablations performed with Ablations performed with VISX S4 laser VISX S4 laser
6 – 6.5 mm optical zone 6 – 6.5 mm optical zone with blend with blend
Amoils brush to remove Amoils brush to remove epithelium to 8mmepithelium to 8mm
Irrigation with cold BSS Irrigation with cold BSS immediately post ablation immediately post ablation
BSCL appliedBSCL applied No prophylactic MMCNo prophylactic MMC
Post-operative RegimenPost-operative Regimen
Flarex QID with 4 Flarex QID with 4 month taper month taper
Ocuflox QID x 7 daysOcuflox QID x 7 days Tetracaine x 24 hours Tetracaine x 24 hours
(“rescue” drop)(“rescue” drop) PO PercocetPO Percocet BSCL removed day 4 BSCL removed day 4
or 7or 7
Total Haze: < 4.00 D Total Haze: < 4.00 D
1 1 MonthMonth
3 3 MonthsMonths
6 6 MonthsMonths
12 Months
Standard Standard PRKPRK
5.7%5.7%
(178/3132)(178/3132)
3.8%3.8%
(91/2374)(91/2374)
3.0%3.0%
(61/2037)(61/2037)
2.2%
(30/1374)
CustomVueCustomVue 4.3%4.3%
(95/2217)(95/2217)
2.2%2.2%
(35/1612)(35/1612)
0.9%0.9%
(10/1091)(10/1091)
0%
(0/536)
P = 0.0231 P = 0.0031 P = 0.0001 P = 0.0001* No haze was significant enough to require treatment
Total Haze: 4.00 D – 6.00 DTotal Haze: 4.00 D – 6.00 D 1 Month
3 Months
6 Months
12 12 MonthsMonths
Standard Standard PRKPRK
6.6%
(271/4130)
4.6%
(142/3120)
5.6%
(150/2692)
3.7%3.7%
(68/1818)(68/1818)
CustomVueCustomVue 4.5%
(125/2794)
2.6%
(53/2031)
1.5%
(21/1396)
0.3%0.3%
(2/683)(2/683)
P = 0.0002 P = 0.0003 P = 0.0001 P = 0.0001* No haze was significant enough to require treatment
Total Haze: 4 – 6 DTotal Haze: 4 – 6 D
0
1
2
3
4
5
6
7
% Haze
One Three Six Twelve
Months
Standard PRK
CustomVue
* No haze was significant enough to require treatment
Total Haze: > 6.00 D Total Haze: > 6.00 D
1 1 MonthMonth
3 3 MonthsMonths
6 6 MonthsMonths
12 12 MonthsMonths
Standard Standard PRKPRK
10.3%10.3%
(20/194)(20/194)
6.9%6.9%
(9/131)(9/131)
25.8%25.8%
(32/124)(32/124)
25.3%25.3%
(20/79)(20/79)
CustomVueCustomVue 5.3%5.3%
(4/76)(4/76)
7.8%7.8%
(4/51)(4/51)
15.0%15.0%
(6/40)(6/40)
5.0%5.0%
(1/20)(1/20)
P = 0.2389 P = 0.7587 P = 0.1984 P = 0.0646* No haze was significant enough to require treatment
ConclusionsConclusions
Less haze seen overall with CustomVue Less haze seen overall with CustomVue treatmentstreatments
Most significant difference at each time point Most significant difference at each time point noted in < 6 D groupsnoted in < 6 D groups
Most likely due to decrease in stromal surface Most likely due to decrease in stromal surface irregularities with wavefront-guidedirregularities with wavefront-guided PRK PRK compared to standardcompared to standard
With larger sample size, may see a significant With larger sample size, may see a significant decrease in haze in larger diopter treatments decrease in haze in larger diopter treatments as wellas well
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