JAN 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 61 of 71

62 EW RESIDENTS Review continued from page 61 56.2% of surgical eyes. A previous publication by Yilmaz, et al.2 re- ported three patients who required explantation of this same inlay; two were for refractive shift and one was for partial inlay extrusion due to an overlying presumed herpetic lesion. A potentially significant issue that deserves more discussion by the authors is the loss of corrected dis- tance visual acuity (CDVA) in some surgical eyes. Nine eyes (28.3%) lost 1 line of CDVA and one eye (3.1%) lost 3.8 lines. Although loss of 1 line of CDVA in the non-dominant eye may not be clinically significant, loss of 3.8 lines probably is. Like- wise, the post-op refractive shifts in some patients, accompanied by a central flattening on corneal topog- raphy, seem to be unpredictable based on the pre-op data presented. A final consideration is the sensitiv- ity of this procedure to decentration (a concept already familiar to mod- ern cataract and refractive surgeons), as manifested by the two patients that required inlay recentration with resultant significant increases in their UNVA and UIVA. We applaud the authors for in- cluding data regarding post-op abil- ity to examine the surgical eyes with standard ophthalmic examination equipment. Funduscopic examina- tion was not affected, although the authors reported only the use of the Goldmann 3-mirror contact lenses for peripheral retinal examination and not binocular indirect ophthal- moscopy. Furthermore, the use of the line scan instead of the volume scan on macula OCT likely con- tributed to the authors' assessment that there was only a "slight de- crease in image quality at the edges." If the volume scan was used (as it often is in clinical practice), this decrease in image quality may have extended to include the major- ity of the paracentral lines superior and inferior to the foveal line scan. This study had many strong points, including length of follow- up, high percentage of follow-up exams, conscientious and thorough design, and thoughtful outcome pa- rameters. Meticulous inclusion and exclusion criteria contributed to their ability to avoid confounding ocular issues and maximize the chance of successful outcomes. Among this study's limitations are limited sample size, narrow age range (48-55 years), and the other issues mentioned above. It is worth noting that two au- THE BEST OF BOTH WORLDS Only the GALILEI G2 merges the Placido and Dual Scheimpflug Technologies into a single measurement. The combined data provide highly accurate values THE BEST OF BOTH WORLDS echnologies into a single measurement. The combined data provide highly accurate values for surgical evaluation and planning, leading to unrivalled clinical results thors have financial interests with AcuFocus, including one author who was involved in post-op patient ex- amination and data collection. Masking of examiners was likely not possible due to the nature of the in- tervention. Nevertheless, we com- mend the authors for reporting further follow-up on this cohort, as the surgical correction of presbyopia is a very timely and relevant topic. This method promises to be rel- atively straightforward, requiring only the skills a competent LASIK surgeon already possesses, with no added nomograms or calculations. Although further studies are war- ranted (including the ongoing U.S. FDA trial), this study demonstrates that we continue to make progress toward the holy grail of presbyopia- correcting procedures—one that combines efficacy, safety, long-term stability, predictability, reversibility, and relative ease of use. EW References Move to the next level of accuracy in Anterior Segment Tomography Ziemer USA, Inc. 321 Ridge Street, Alton, IL 62002, USA Call 866-708-4490 or visit www.ziemergroup.com for further information about how GALILEI G2 can improve outcomes for your patients Call 1-866-708-4490 or visit www.ziemergroup.com for further information 1. Seyeddain O, Riha W, Hohensinn M, et al. Refractive surgical correction of presbyopia with the AcuFocus small aperture corneal inlay: two-year follow-up. J Refract Surg 2010;26:707-715. 2. Yilmaz OF, Bayraktar S, Agca A, et al. Intracorneal inlay for the surgical correction of presbyopia. J Cataract Refract Surg 2008;34:1921-1927. Contact information Mifflin: mark.mifflin@hsc.utah.edu January 2012

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