Financial  Disclosure    Dr.  Tomita  is  a  consultant  for    SCHWIND  Eye-­‐Tech-­‐Solu<ons,  Ziemer  Ophthalmic  Systems  AG,  and  AcuFocus  Inc.  

Shinagawa LASIK Center

Medical Director, Shinagawa LASIK Center, Tokyo, Japan 　Adjunct Professor, Department of Ophthalmology, Wenzhou Medical College, Wenzhou, China

1,149,036  Femto  LASIK  cases  since  being  established  in  2004.

   Shinagawa  LASIK  Center  in  Tokyo  with  5  branch  clinics.  We  have  a  total  of  131  doctors.  Our  clinics  perform  approx.  70%  of  the  LASIK  procedures  in  Japan.

Other  procedures  also  available:  ● Surface  abla+on  (PRK,  LASEK,  EpiLASIK)  ● Intrastromal  corneal  ring  segments  ● Phakic  IOLs        ● Mul+-­‐focal  IOLs  ● KAMRA™  Intracorneal  Inlays  ● CK  (Conduc+ve  Keratoplasty)  

14  Units

Visx  star  S4  IR™  (AMO,  USA)

9 Units

AMARIS    (SCHWIND,  Germany)

IntraLase™  FS60  &      iFS  (AMO,  USA)

FEMTO  LDV™,  Crystal  Line  &  Z6  (9  units)    (Ziemer,  Switzerland)

23  Units

1  Unit

Refrac+ve  Suite    (Alcon,  US)

19  Units

ALLEGRETTO  Wave®  Eye-­‐Q      (Alcon,  USA)

KXL  System™,      (Avedro,  USA) 11  Units    

3  Units

✔ Correcting various degrees of myopia and astigmatism

✔ Can be mixed with other refractive surgeries

and/or

Keraring offers variable sizes in order to match every patient’s needs

Keraring implantation is effectively combined with Crosslinking/Intraocular lens/Photorefractive keratectomy (PRK) in order to achieve maximum effect.

and/or

Keraring Crosslinking Intraocular lens PRK

“

Intracorneal ring implantation operated at Shinagawa LASIK center between 2006 and August 2013

Keraring86%

Intacs14%

ü  Keraring’s efficacy even for severe keratectasia/keratoconus makes it our doctors’ choice.

Keraring Crosslinking OCT-guided femtosecond laser

Intracorneal inlay implantation is an effective surgery in order to treat keratoconus and keratectasia. Corneal Crosslinking (CXL) is reportedly effective in preventing progression of keratoconus and keratectasia. In this study, simultaneous Keraring implantation using OCT-guided femtosecond laser and Crosslinking was performed and its effect was evaluated.

Subjects

•  10 eyes of 9 ectatic patients (Male: 7 eyes of 6 patients; Female: 3 eyes of 3 patients)

1.  Tunnel creation using OCT-guided femtosecond laser (Femto LDV Z6, Ziemer, Port, Switzerland)

2.  Insertion of ring(s) 3.  0.25% Riboflavin injection into the tunnel. Soak for 5 min. 4.  UVA irradiation (45 mW/cm2, 2 min 40 sec)

•  Uncorrected and corrected distance visual acuity (UDVA and CDVA) •  Manifest refraction •  K mean (Pentacam) •  K max (Pentacam) •  Corneal higher order aberrations (corneal HOAs) •  Corneal endothelial cell density (ECD) •  Central corneal thickness (CCT) •  Corneal topography (Pentacam)

Surgical Method

Pre and Postoperative examination

Femto LDV Z6 ̃ OCT guided femtosecond laser

Depth of the tunnel is virtually confirmed for the precise ring implantation.

Vertical Scan

Horizontal Scan

“C” shaped tunnel

▲Before  cut

▲After  cut

▲Before  cut

▲After  cut

Vertical Scan Horizontal Scan

Ziemer (Port, Swiss)

Surgical Video

*

**

*P = 0.0077 **P = 0.0180

ü  After 3 months, UDVA and CDVA were significantly improved from preoperative.

UDVA and CDVA (Decimal/Snellen)

0.19

0.52

0.660.69

0.99

1.20  

1.27 1.27

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Pre  (n  =  10)

1W  (n  =  10)

1M  (n  =  10)

3M(n  =  10)

UDVA

CDVA

(20/16)

(20/20)

(20/100)

(20/25)

(20/50)

(20/32)

*

**

*P = 0.0077 **P = 0.0180

*Wilcoxon signed-rank test

0.35

-­‐1.05

-­‐0.10   -­‐0.23

-­‐2

-­‐1

0

1

2

Pre  (n  =  10)

1W  (n  =  10)

1M  (n  =  10)

3M(n  =  10)

Spherical and Cylindrical change

Sphere (D) Cylinder (D)

ü  After 3 months, cylinder was significantly improved from preoperative.

-­‐4.25

-­‐2.25 -­‐2.38

-­‐2.38

-­‐5

-­‐4

-­‐3

-­‐2

-­‐1

0

Pre  (n  =  10)

1W  (n  =  10)

1M  (n  =  10)

3M(n  =  10)

*

*P = 0.0166

*Wilcoxon signed-rank test

K mean and K max

K mean (D) K max (D)

ü  After 3 months, K mean and K max were significantly improved from preoperative.

42.88 41.60   41.50  

41.54

38

40

42

44

46

Pre  (n  =  10)

1W  (n  =  10)

1M  (n  =  10)

3M(n  =  10)

51.88 49.3148.72

48.41

44

48

52

56

Pre  (n  =  10)

1W  (n  =  10)

1M  (n  =  10)

3M(n  =  10)

* *

*P = 0.0117 *P = 0.0051

*Wilcoxon signed-rank test

ü  After 3 months, corneal HOA’s were significantly improved from preoperative.

Corneal Higher Order Aberrations

S3 (μm) S4 (μm)

2.021.23

0.99

0

0.5

1

1.5

2

2.5

3

Pre  (n  =  10)

1M  (n  =  8)

3M(n  =  10)

1.080.82

0.59

0

0.4

0.8

1.2

1.6

2

Pre  (n  =  10)

1M  (n  =  8)

3M(n  =  10)

**

*P = 0.0117 *P = 0.0499

*Wilcoxon signed-rank test

ü  After 3 months, ECD and CCT did not change significantly from preoperative.

ECD and CCT

ECD (cells/mm2) CCT (μm)

*Wilcoxon signed-rank test

2912 30202843 2903

0

500

1000

1500

2000

2500

3000

3500

Pre  (n  =  10)

1W  (n  =  9)

1M  (n  =  10)

3M(n  =  9)

424.1 422.7 425.2 422.5

0

100

200

300

400

500

Pre  (n  =  10)

1W  (n  =  10)

1M  (n  =  10)

3M(n  =  10)

NS* NS*

*NS = Not significant

Corneal Topography

Pre OP 3M Post OP Difference

ü  Corneal topography was improved from preoperative after 3 months.

ü  At 3 months postoperative, Uncorrected and Corrected distance visual acuity, cylinder, K-value (mean and max), and corneal HOAs were significantly improved from preoperative.

ü  No significant difference was observed in ECD and CCT after 3 months postoperative when compared to preoperative value.

ü  Corneal topography was improved following the treatment.

ü  Using OCT-guided Femto LDV Z6, the tunnel for the ring implantation was safely created.

Simultaneous Keraring implantation using OCT-guided Femto LDV V6 and Crosslinking was effective for the treatment of keratectasia

April 1, 2014

Register at www.isrstokyo.org

Registration Fee $150 U.S.

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