CENTRO OFTALMOLOGICO GUSTAVO TAMAYOBOGOTA COLOMBIA

GUSTAVO TAMAYO MD CLAUDIA CASTELL MD

PILAR VARGAS MD

LASIK XTRA

From: BOGOTA LASER REFRACTIVE INSTITUTE Bogota, Colombia

DISCLOSURES FOR GUSTAVO TAMAYO MD

1. Member of the Advisory Board for AMO Inc.

2. Member of the Advisory Board PRESBIA Corp.

3. Member of the Advisory Board EYEGENICS Corp.

4. Member of the Speakers Group for AVEDRO

5. Member of speakers group of KERAMED

6. Patent holder of a Presbyopia treatment

LASIK XTRA

1. A new concept: KXL at the time of a LASIK surgery.

2. There is no doubt any surgery involving the creation of a flap will decrease the strength of the cornea.

3. Microkeratomes decrease the corneal strenghth two times more than Femtosecond flaps (own published studies).

4. If the addition of KXL does not change the final result: WHY NOT?

LASIK XTRA

1. Very short procedure: one minute soaking time and one minute fifteen seconds UV.

2. Does not change the normal LASIK procedure itself.

3. Same ablation, same handling of the flap.4. In my own cases we did not detect any change

in the refractive result.5. No complications added at all to the normal

regular procedure of LASIK.

INCORPORATING LASIK XTRA INTO STANDARD LASIK SURGERY

1. Following excimer laser ablation in the flap bed

Avedro’s VīBex Riboflavin is applied to the flap bed:

Isotonic 0.1% riboflavin 20% Dextran T500pH 7.0

2. The flap is repositioned and the cornea is then

exposed to 30mW/cm2

UVA for 2 minutes

LASIK XTRA ADVANTAGES

1. Can be carried out with Intralase or with Microkeratome flap.

2. Do not change the regular procedure.3. Easy and simple for Doctor and Patient.4. Do not change the final result of the ablation.5. Can also be used regardless of the thickness

of the flap, depth of ablation or type of Excimer Laser.

LASIK XTRA DISADVANTAGES

1. Slows down the procedure for a couple of minutes.

2. Increases the cost.

LASIK XTRA INDICATIONS

STRONG CONSIDERATIONS

1. ABSOLUTELY CONTRAINDICATED IN THE PRESENCE OF ECTASIA.

2. ABSOLUTELY NOT INDICATED WHEN DEVELOPMENT OF ECASIA IS WARRANTED.

3. In such a case I prefer Surface Ablation plus Accelerated Cross Linking.

LASIK XTRA INDICATIONS

1. Young patients for Lasik (under 24 years of age).

2. Patients with severe ocular allergies, due to the risk of heavy rubbing.

3. Completely normal corneas, with no one sign of Keratoconus, but family history.

4. Thin corneas with complete normal preoperative evaluation (Risk of ectasia has been ruled out).

5. High myopes (large resections)

LASIK XTRA INDICATIONS

6. Retreatments, particularly if the thickness of the flap is not known.

7. Unexpected thick flap.

8. Irregular flaps with different thickness.

9. FINALLY IN ALL LASIK CASES: IF IT DOES NOT CHANGE THE RESULT WHY NOT???

LASIK XTRA: Predictable Visual Outcomes

Retrospective Comparison of 66 Lasik eyes to 42 LASIK eyes treated for myopia

Mean age: 26.55 in the Lasik Xtra cohort and 27.28 in the LASIK cohort

Mean preoperative MRSE was -2.97 D (Lasik Xtra), and -2.25 D (LASIK).

No adjustment was made to the excimer laser treatment nomogram to account for aCXL, which was performed immediately following stromal ablation

LASIK XTRA: Predictable Visual Outcomes

Retrospective Comparison of 66 Lasik eyes to 42 LASIK eyes treated for myopia

Mean UCVA at 1 Day Post-Op20/21 Lasik Xtra vs 20/20 LASIK

Mean UCVA at 1 Week Post-Op20/20 Lasik Xtra vs 20/20 LASIK

Mean UCVA at 1 Month Post-Op20/18 Lasik Xtra vs 20/20 LASIK

LASIK XTRA: Predictable Visual Outcomes

Retrospective Comparison of 66 Lasik eyes to 42 LASIK eyes treated for myopia

Mean MRSE at 1 Week Post-Op+0.17 Lasik Xtra vs -0.73 LASIK

Mean MRSE at 1 Month Post-Op+0.49 Lasik Xtra vs +0.17 LASIK

LASIK XTRA: Predictable Visual Outcomes

16%

63%

16%

5%

LASIK

20/1520/2020/2520/3020/40

2%

80%

17%

2%

Lasik Xtra

UCVA 1 Day Post Operative

LASIK XTRA: Predictable Visual Outcomes

UCVA 1 Day Post Op LASIK

12%

81%

4%4%

LASIK

20/1520/2020/2520/3020/40

32%

61%

3%3%

Lasik Xtra

UCVA 1 Month Post Operative

LASIK XTRA EXAMPLE # 1PREOPERATIVE POSTOPERATIVE

LASIK XTRA EXAMPLE # 2

PREOPERATIVE POSTOPERATIVE

LASIK XTRA EXAMPLE # 2PREOPERATIVE POSTOPERATIVE

CONCLUSION LASIK XTRA

No need to change nomogram for LASIK procedures (Femto or microkeratome).

No change in the final results when compared to same procedures without KXL.

No haze or loss of lines of BCVA. Time for surgery is increased only few more

minutes. Follow up only one year and one eye

retreatment in 100 eyes. Lifting the flap was very easy (surgeon was

not aware of the KXL at the time of relifting).

Gracias