Correction of Presbyopia

with Kera No-touch

technique

Jae Chan Kim M.D., Ph.D.,

Department of Ophthalmology
Chung-Ang University
 Refractive regression :
major challenge after refractive surgery

Why?

Inconsistensy of wound healing after refractive surgery

 Refractive regression process predominate in regions of greater tissue removal

(William J Dupps Jr, etc. Experimental eye research 2006)

 Disruption of epithelium over central cornea in PRK amplifies the wound healing
response and accounts for higher rates of regression and haze

(R.R Mohan, etc. Exp. Eye 2003)

Concept :
Refractive regression : major challenge after refractive surgery

Enhanced early wound healing improves final visual outcome

by inhibition of regression?

Preservation of central corneal epithelium

in corneal ablation surgery
lead to
shortening of early wound healing time
decrease of refractive regression
 No-touch surgery in presbyopia
?
Object: emmetropia c mild hyperopia

* Dual flying spot * Smooth ablation c no ridge

homogenous energy delivery effective corneal ablation

* Small beam size :0.44mm

& Random projection
delicate ablation
& more accurate treatments
Inventor : George huang Ph.D.
Idea from Jae Chan Kim M.D.
Woo chan Park M.D., Byung moo Min M.D.
 Corneal ablation method
& Concept of early wound healing
<Emmetropia – Ablation of zone 2 only>
•Center - Distance vision
Ablation zone
: Spherical curvature
No-touch zone(3.5~4.2mm) 1.Fa
r
•Paracentral& Peripheral 2.
Near
- Near Vision
: Aspherical curvature
Doughnut shape Epithelial migration
Central epithelium ; more faster
than Peripheral epithelium
Bidirectional wound healing
 Materials & Measurements
 10 patients, 12 eyes
 M:F = 6 : 4, 51.2 years old (43-60)
 Emmetropia c mild hyperopia(SE ≤ ±1.25D)
- mean S.E. : 0.78D

 December, 2007~ June,2008

 F/U: postoperative 1, 4, 30days

 Measurements
- Far and near uncorrected visual acuity
- DOF, depth of focus
- Topography (Humphrey® ATLAS™, Zeiss)
- Aberrometer (WASCA aberrometer, Zeiss)
- Contrast sensitivity (CSV-1000E, Vector vision)
- Rate of corneal wound healing
 Result: Corneal epithelial wound healing rate
Postop. Postop.15hrs POD#4

Total ablation
S.E 0.75
Ablation depth 39Mm

Postop. Postop.15hrs POD#4

No-touch
S.E 0.5 Postop. Postop.15hrs POD#4
Ablation depth 35Mm
Comparison of corneal epithelial wound healing days
*

wound healing days

5

4 4.5days

1 1.3days

0 MEL80 no- touch

Significant at P<0.05 at t-test

 Result: IsoBeam D200 No-touch zone
(3.7~4.2mm) comparison of MEL80
Central zone : 3.7~4.2mm
5Pts. (6eyes)
emmetropia (mean S.E: 0.72)

Far vision Log MAR Near vision

1.4
1.2 2.4days ?
-0.2
- 0.1
1
0.8
?
1 0.0
5.2days 0.6 1.2days
0.8 + 0.1
0.5
0.6 + 0.2
0.4 2.3days
0.4 + 0.4

0.2 + 0.7 0.2

0 +1 0
PO 1
#2

#4

1Y

PO 1
#2

#4
PO p

1Y
PO ..
..

PO p

PO ..
..
#

#3

#3
eo

eo
D

D
D

D
D

D
PO
Pr

PO
Pr
PO

PO
UCNVA(no touch) UCNVA(MEL 80) DUCVA(no touch) DUCVA(MEL 80)
 Summary
 Wound healing days by IsoBeam No-touch technique
was significantly more faster than that by MEL-80

 Effective near & far vision by IsoBeam was significantly

more faster achieved by preserving of central cornea
epithelium than that by MEL-80

 Expect to good final visual outcome due to faster

epithelial wound healing time by preserving central
cornea epithelium
 Modulation of final visual outcome
by early wound healing

 Reduction of corneal ablation area &

preservation of central corneal epithelium
Bidirectional wound healing
shortening of early wound healing days
decrease of refractive regression