Prk Vs Lasik

Presbyopia Correction for Middle Aged High Myopia

Case of High Myopia Patient F/47 HOO 2008.4.15. First visit CC) Far & Near vision disturbance MR OD : -12.0sph

OS : -7.25sph = -1.5cyl A135 Add : +1.5D (OU)

1) 2008.9.2/9.4

OD) +10D Alcon IQ IOL insertion OS) +13.5D Alcon IQ IOL POD #2M

UCVA Far : FC/0.04 Near : J16/J16 BCVA

Far : 0.5/0.7 Near : J5(0.333)/J7(0.287)

2nd Step : Keralaser presbyopia correction

MR(OD) UCVA(OD) BCVA(OD)

2) 2008.11.19 POD #1D

Surgical Plan (OU): 1st Step : Cataract operation

Phaco with IOL (OU)

-2.25D sph. Far : 0.3 Near : J1 (0.8) Far : 0.8 Near : J1+(1.0)

Keralaser (OD)

UCVA(OD)

Far : 0.8 Near : J1+ (1.0)

Kera Pesbyopia #1D

Phaco+IOL #2M

Short Term Result of Presbyopia Correction Using Kera Laser

Method & Patients

Prospective clinical trial ▪ Period : 03. 2008 ~ 10. 2008 by Park Woo Chan ▪ Group : 40 Eyes * Myopic Presbyopia (24 eyes) (PRK:LASIK = 13:11) * Hyperopic Presbyopia (16 eyes) (PRK:LASIK = 0:16)  Follow up: 1 주일 , 2 주일 ,1 개월 , 2 개월 , 3 개월 , 6 개월

Pre& postoperative examinations • • • • • • • • • • • • •

UCVA (Far & Near) BCVA (Far & Near) AR, MR, Wavefront refraction Slit lamp examination Keratometer Topography Pachymeter Pupillometer Specular microscopy BUT, Schirmer test Corneal sense by Cochet-Bonnet aesthesiometer IOP, VF, OCT Contrast sensitivity (CSV-1000) mesopic, photopic & halogen • Wavefront Aberration Analysis (LadarWave) • Fundus examination

Method • 수술은 한 명의 술자 (Park Woo Chan) 에 의해 시행 • PRK 군은 모두 띠모양 양막과 T-lens 사용함 . • LASIK 군은 Hansatome® 을 이용해 160 ㎛의 각막절편 • • 통계 분석은 SPSS(release 12.0K) 의 T-test 와 , 상관관계 를 알아보기 위해 피어슨 상관계수 (Pearson correlation coefficient) 를 이용하였고 , P<0.05 를 통계학적으로 유의하 다 하였다 .

Demography Eyes Male/Femal e (eyes)

Age

Mean F/U period (month)

Myopic Presbyopia

24

3/21

51.25 ± 3.18

4.17 ± 1.74

Hyperopic Presbyopia

16

6/10

53.88 ± 4.86

2.50 ± 1.71

Total

40

9/31

52.30 ± 4.09

3.50 ± 1.89 (range: 1~7 month)

Biometry Myopic Presbyopia (24 eyes)

Hyperopic Presbyopia (16 eyes)

Total (40 eyes)

Pupil Size (mm)

6.50 ± 0.79

5.53 ± 0.64

6.11 ± 0.87

Central CT (um)

574.67 ± 24.10

552.56 ± 29.10

565.83 ± 28.08

2350.71 ± 414.88

2467.38 ± 347.01

2397.38 ± 388.81

14.46 ± 2.47

16.13 ± 2.78

15.13 ± 2.69

Schirmer Test (mm)

6.13 ± 5.19

8.00 ± 6.25

6.88 ± 5.63

BUT (sec)

5.59 ± 2.94

6.29 ± 2.97

5.86 ± 2.93

Corneal Sense (cm)

5.44 ± 0.53

5.50 ± 0.58

5.42 ± 0.52

Preop. SE (D)

-2.86 ± 1.87 (-0.125 ~ -6.125)

0.84 ± 0.50 (0 ~ +1.75)

Endothelial CD IOP (mmHg)

CT = Corneal Thickness,

CD = Cell Density, SE = spherical equivalent

Results

PRK vs LASIK in Myopic Presbyopia

J1 J1+ J1 J2 J3 J5 J10 J16

J3 J5 J10

PRK vs LASIK in Myopic Presbyopia (D)

Change of Visual Acuity 근시성 노안 (Far)

근시성 노안 (Near)

1. 2

1. 2

1. 0

1. 0

0. 8

0. 8

0. 6

0. 6

0. 4

J1+ J1 J2 J3 J5 J10 BCVA(N)

0. 4 BCVA(F)

0. 2

UCVA(F)

0. 0

0. 2

UCVA(N) J16

0. 0 술전

1주

2주

1개월

2개월

3개월

6개월

술전

1. 2

1. 2

1. 0

1. 0

0. 8

0. 8

0. 6

0. 6 BCVA(F)

0. 2

UCVA(F)

0. 0 술전

1주

2주

1개월

2개월

2주

1개월

2개월

3개월

6개월

원 시성 노 안 (Near)

원 시 성 노안 (Far)

0. 4

1주

3개월

J1+ J1 J2 J3 J5 BCVA(N)J10 J16 UCVA(N)

0. 4 0. 2 0. 0 술전

1주

2주

1개월

2개월

3개월

Gain & Loss of Visual Acuity

Eye

POD : 3mo

Cumulative UCVA (%)

근시 노안 (Far)

(%)

근시 노안 (Near)

J1+

(%)

원시 노안 (Far)

J1+~J2

J2~J3

J3

원시 노안 (Near)

(%)

J1+

J1+~J2

J2~J3

J3

Change of Spherical Equivalent 근시 노안

(D) 0. 5 0. 0 - 0. 5 - 1. 0 - 1. 5 - 2. 0 - 2. 5 - 3. 0 - 3. 5 술전

1주

2주

1개월

2개월

3개월

6개월

원시 노안

(D) 1. 0 0. 8 0. 6 0. 4 0. 2 0. 0 - 0. 2 - 0. 4 - 0. 6 - 0. 8 술전

1주

2주

1개월

2개월

3개월

Achieved vs Attempt Correction (D)

(D)

(D)

(D)

Pearson 상관계수 : 0.890, P=0.000 ≤ ± 0.5 D : 55.00% (n=20) ≤ ± 1.0 D : 57.45%

Pearson 상관계수 : 0.493, P=0.104 ≤ ± 0.5 D : 83.33% (n=12) ≤ ± 1.0 D : 91.67%

POD : 3mo

Change of High Order Aberration (6 mm OZ)

(um)

(um)

Change of Contrast Sensitivity Photopic

Mesopi c

Haloge n

3 cpd

6 cpd

12 cpd

18 cpd

3 cpd

6 cpd

12 cpd

18 cpd

3 cpd

6 cpd

12 cpd

18 cpd

근시

술전

5.04

4.79

4.67

4.46

5.00

4.79

4.21

4.13

4.92

4.92

4.04

4.54

노안

1 개월

4.94

4.39

3.78

4.00

4.78

4.72

3.94

4.06

4.61

4.33

3.89

4.11

2 개월

5.31

5.15

4.92

4.54

5.23

5.15

5.00

4.46

4.92

4.69

4.85

5.00

3 개월

5.00

4.82

5.00

4.18

5.18

4.82

4.64

4.27

5.09

4.91

4.64

4.00

6 개월

5.50

5.00

5.00

4.75

5.63

4.88

5.13

4.75

5.50

4.88

4.75

4.63

3 cpd

6 cpd

12 cpd

18 cpd

3 cpd

6 cpd

12 cpd

18 cpd

3 cpd

6 cpd

12 cpd

18 cpd

원시

술전

5.00

5.19

5.25

5.13

5.13

5.06

4.75

5.00

5.00

4.94

4.75

5.13

노안

1 개월

5.10

5.30

4.70

4.90

5.00

5.20

4.60

4.90

5.10

4.70

4.30

5.00

2 개월

5.00

5.50

4.50

5.50

4.00

5.50

4.75

4.25

5.00

5.25

4.25

5.00

3 개월

5.00

5.50

5.00

5.50

5.00

5.00

5.00

5.50

5.00

5.00

5.00

5.00

6

근시 노안

5 4 3 2

Photopic

1 0 3 cpd

6 cpd

12 cpd

18 cpd

6 5 4 3 2

Mesopic

1 0 3 cpd

6 cpd

12 cpd

18 cpd

6 5 4 3 2

Halogen Glare

1 0 3 cpd

6 cpd

12 cpd

18 cpd

6

원시 노안

5 4 3 2

Photopic

1 0 3 cpd

6 cpd

12 cpd

18 cpd

6 5 4 3 2

Mesopic

1 0 3 cpd

6 cpd

12 cpd

18 cpd

6 5 4 3 2

Halogen Glare

1 0 3 cpd

6 cpd

12 cpd

18 cpd

Change of other factors

Change of other factors PRK

LASIK