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EW REFRACTIVE SURGERY
August 2014
patients had 20/25 or better BCDVA,
and no one fell below 20/30.
Managing cases
Dr. Pepose said that in all patients,
but particularly in those with
fluctuating vision, it is important
to aggressively treat dry eye both
preoperatively and postoperatively.
"The use of pulsed topical ste-
roids has been effective in the ma-
jority of cases that showed evidence
of a hyperopic change in refraction,"
he said. Additionally, for patients
who cannot adapt to the inlay or
do not have a reversal of hyperopic
shift with steroid treatment, early
removal of the inlay resulted in
more rapid return and stabilization
of visual acuity.
Dr. Pepose recommended that
surgeons monitor epithelial in-
growth and treat it by scraping or
other standard methods. "Those
who have difficulty adapting should
be encouraged to be patient and
practice reading in good lighting,"
he said. "If they cannot adapt and
other issues such as dry eye have
been looked for and treated, inlay
removal is possible."
There have been some issues
with cosmesis, which should be
discussed with patients with lightly
colored irides, Dr. Pepose said.
"The inlay should be removed
in patients who will need to have
unfocused retinal laser treatment,
as this can produce thermal damage
to the inlay," he said, adding that it
should also be removed prior to con-
sideration of creating a subsequent
femtosecond flap.
"The efficacy speaks for itself,"
Dr. Vukich said. The KAMRA corneal
inlay helps to address an issue for
presbyopic patients with minimal
safety concerns. There was no sig-
nificant corneal rejection or loss of
BCVA of 2 lines or more, he said.
Equally important, Dr. Vukich
said, the KAMRA inlay is removable
if a problem arises. "The reality is, it
can be removed as easily as it can be
placed."
The KAMRA and other corneal
inlays are the first of their kind, he
said. "As a category, what we're look-
ing at is establishing that the intra-
lamellar corneal space is something
that can be used safely to correct
vision." Biocompatibility materials
have improved to a point that this is
a real option, Dr. Vukich said. EW
Editors' note: Drs. Vukich and Pepose
have financial interests with AcuFocus.
Contact information
Pepose: jpepose@peposevision.com
Vukich: javukich@gmail.com
