Data favorable for femtosecond laser intrastromal procedure

April 23, 2012

Strict inclusion criteria exist for using a femtosecond laser flapless intrastromal procedure (IntraCor, Technolas Perfect Vision) to treat presbyopia. Results from medium-term follow-up show that, in appropriate candidates, it is associated with excellent functional outcomes, good safety, and high patient satisfaction, said Claire Hartnett, MD.

Chicago-Strict inclusion criteria exist for using a femtosecond laser flapless intrastromal procedure (IntraCor, Technolas Perfect Vision) to treat presbyopia. Results from medium-term follow-up show that, in appropriate candidates, it is associated with excellent functional outcomes, good safety, and high patient satisfaction, said Claire Hartnett, MD.

Dr. Hartnett, Mater Private Hospital, Dublin, Ireland, presented experience from a study launched in early 2010 that included 67 patients with a mean age of 52 years (range 42 to 65). All patients underwent the procedure only in the nondominant eye. They were eligible if they had a near add requirement of at least +1.5 D, distance refraction between 0 and +1 D SE, cylinder up to 0.5 D, and pachymetry at least 500 μm.

Mean near uncorrected visual acuity (UCVA) was N18 preoperatively, improved to N5 at 6 weeks, and remained N5 at 24 months. At 12 months, 91% of patients had achieved spectacle independence and were reading N8 or smaller in good natural lighting conditions, but 60% of patients needed reading glasses in dim lighting conditions. The treatment caused an early myopic shift; at 2 years mean refraction was –0.31 D SE and 16% of patients experienced a noticeable reduction in distance UCVA.

About one-fourth of patients reported glare and halos after the procedure, but the symptoms were not debilitating for any patient and they also improved over time. Other safety data showed no evidence of corneal ectasia or change in endothelial cell count, and stereopsis testing showed no loss of binocular depth perception.

“There are restrictions in terms of patient eligibility for this procedure, and candidates must be counseled about the potential for loss of distance visual acuity, which averaged 1 logMAR line in our study,” Dr. Hartnett said. “However, our survey data showed a 91% patient satisfaction rate, and we feel the femtosecond laser intrastromal procedure offers a very good option for presbyopic correction.”

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