CK effective in low-level hyperopia, hyperopic astigmatism

September 15, 2004

San Diego-Conductive keratoplasty (CK) is proving to be a versatile procedure that also can be used as an off-label procedure to enhance the vision of patients who have undergone cataract extraction. The visual results were excellent and patients expressed satisfaction. CK may be a more attractive procedure for this patient group because of safety and economic considerations, according to Louis D. "Skip" Nichamin, MD.

San Diego-Conductive keratoplasty (CK) is proving to be a versatile procedure that also can be used as an off-label procedure to enhance the vision of patients who have undergone cataract extraction. The visual results were excellent and patients expressed satisfaction. CK may be a more attractive procedure for this patient group because of safety and economic considerations, according to Louis D. "Skip" Nichamin, MD.

"As good as our refractive outcomes are getting, we still need to avail ourselves of various enhancement techniques. I have become a big advocate of bioptics, and part of the bioptics arsenal in my practice is the off-label use of CK," he said, during the annual meeting of the American Society of Cataract and Refractive Surgery.

Dr. Nichamin, in private practice in Brookville, PA, explained why he often opts for CK rather than hyperopic LASIK enhancement.

Many advantages"CK is perceived as less involved and less threatening than excimer laser procedures by older patients, making the procedure more amenable to that patient group. CK tends to be a more affordable treatment compared with excimer laser treatment. Perhaps most importantly, CK has potential safety advantages in that it eliminates the need to cut flaps and remove tissue in older patients and spares the visual axis," he continued.

He has experienced good efficacy using CK for enhancement after cataract extraction and IOL implantation. At the time of this report, he and his colleagues treated 22 eyes of 21 patients using standard cataract extraction techniques. The mean preoperative sphere in this group of patients was 1.25 D, which ranged up to 3 D. Eighteen of the 22 eyes were targeted for emmetropia; in the other four eyes, the patients desired more near vision. In 15 of the 22 eyes there was about 1 D of astigmatism, which was also treated.

"In the 18 eyes corrected to emmetropia, the mean sphere went from 1.28 D to an impressive 0.18 D (range, +0.5 to -0.5 D). The cylinder correction in the 15 patients decreased to 0.38 D postoperatively," he reported.

Thus far, patient satisfaction is high and no complications have developed.

In a typical case, an 82-year-old man had had an extracapsular procedure. When the patient presented to Dr. Nichamin, the man was hyperopic from the previous surgery to match the refraction in the fellow eye. Dr. Nichamin opted to perform CK on the pseudophakic eye followed by phacoemulsification to reduce the refractive error. A 24-spot treatment was performed. One month after surgery there was slight hyperopia, but the patient was pleased with the result and opted for emmetropia in the second cataractous eye.

"In our experience, CK is proving to be an effective modality to reduce low levels of hyperopia and hyperopic astigmatism after cataract implantation. The safety profile of this procedure is particularly attractive in an older population of patients. The logistics and economics of CK may prove to be more attractive than other treatment options," Dr. Nichamin concluded.