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The Bausch and Lomb Zyoptic Custom Ablation System

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The Bausch and Lomb Zyoptic Custom Ablation System Powered By Docstoc
					90, 100 & 110 Micron Flap Using
Small Bubble Femtosecond Laser


        Scott M. MacRae MD
    Professor of Ophthalmology
    Professor of Visual Science
      University of Rochester

   Dr. MacRae is a paid consultant to
                Ziemer
                             UNIVERSITY OF ROCHESTER
Purpose: Compare Outcomes 90 vs
  110 Micron Ziemer LDV Flaps

• 25 Eyes in each group
• Mean SE
  – 90 micron group: - 6.3 D Sph. -1.0 D Cyl.
  – 110 micron group: -4.2 D Sph. -0.6 D Cyl.




                              UNIVERSITY OF ROCHESTER
 Visual Results: 90 vs 110 Micron
   LDV Flaps – 3 Months Postop
• 90 Micron Postop:           • 110 Micron
   – SE -0.145 D + 0.34 D       – SE -0.15 D + 0.30 D
   – Sph. -O.01                 – Sph. -0.05 D
   – Cyl. -0.22D                – Cyl. -0.20 D
   – Mean UCVA -0.02            – Mean UCVA -0.04
     (20/20)                      (20/20)
   – Mean BCVA -0.07            – Mean BCVA -0.09
     (20/16)                      (20/16)
   – 92% of eyes + 0.5 D of     – 96% of eyes + 0.5 D of
     Plano                        Plano


• 90 & 110 Micron Flaps
  obtained similar results



                                       UNIVERSITY OF ROCHESTER
      LDV Nomogram
Univ. of Rochester/Ziemer
Keratometry       White to   Ring   Hinge Width       Hinge Width
Readings          White      Size   90 µm flap        100 & 110 µm
                                                      flap
Steep K’s >46.5   11.5 &     9.0m   0.5 mm            0.5 mm
                  smaller    m
Steep K’s >       11.5 &     9.0    0.5 mm            0.5 mm
46.5              larger
44.50 - 46.50     11.5 &     9.0    0.5               0.5
                  smaller

44.5 - 46.50      11.5 &     9.0    0.5               0.5
                  larger
Average K’s       11.5 &     9.0    0.5               0.5
42.00- 44.50      smaller
Average K’s       11.5 and   9.0    0.5               0.5
42.00-44.5        larger
Flat K’s          11.5 and   9.0    0.6               0.6
<42.00            smaller
Flat K’s          11.5 and   9.5    0.6           UNIVERSITY OF ROCHESTER
                                                      0.6
<42.00            larger
LDV Optimal Flap Management
• Control hydration – Dry LASIK
• Control flap thickness Ziemer:
   – Dry ultrasound flap measurements reduces Standard
     Deviation
   – LDV 110 µm separating @ 105 + 7.2 µm
   – LDV 90 µm separating @ 90.2 + 5.7 µm
   – Working at “Five sigma”
• Position flap optimally “as if it never moved”
• 90 micron:
   – More delicate, drier – “potato chip
   – Hourly prednisolone acetate day of surgery, no
     rainbow glare or haze compared to IL
   – Stretch flap in “Butterfly Technique”, no microstria


                                          UNIVERSITY OF ROCHESTER
Intraoperative Pachymetry:
Dry Method- Dry Before First
       Measurement




                   UNIVERSITY OF ROCHESTER
Ziemer LDV Smaller Spot Size
“Small Bubble” Strategy
• Less energy concentrated in one
  area
  – Similar to spreading laser spots out with
    femto – reduces thermal energy and
    cavitation
    •   Cavitation rare
    •   No Transient Light Sensitivity Syndrome
    •   No rainbow glare, haze reactions
    •   No Opaque Bubble Layer




                                     UNIVERSITY OF ROCHESTER
Advantages of Ziemer LDV
Femtosecond Small Spot Strategy

• Thin flap - 90 µm strategy allows
  LASIK treatment thin corneas
  previously needing PRK
  – Minimal or no risk of cavitation,
    inflammation, haze, or rainbow glare
• Allows deeper Rx with pockets,
  tunnels or deep lamellar RX without
  using high energy again reducing
  inflammation and corneal edema

                              UNIVERSITY OF ROCHESTER
     90 Micron LDV Femto
• Small bubble technology:
  – Makes epithelial breakthrough much
    less likely
  – Opaque Bubble Layer (OBL) minor issue
    with LDV
• Start conservatively and handle like
  a EpiLASIK flap
• Patients appreciate avoiding PRK!


                             UNIVERSITY OF ROCHESTER
 New Ziemer LDV 100 Micron
     Interspace Shields
• Best of both worlds
• LDV 100 µm separating @ 98 + 9 µm
  – My Preferred flap thickness
  – Minimizes PRK
  – Easy to handle and greater comfort factor than
    90 microns.
  – Use same settings as 110 microns
  – Flaps behave like 110 micron flaps
  – Allows transition to 90 microns when needed
    with greater confidence
  – Still use 90 microns confidently in to optimize
    thin flap strategy


                                    UNIVERSITY OF ROCHESTER
Summary 90, 100 & 110 Micron
Flaps with Ziemer LDV
• Outcomes Similar for 90 and 110
  microns
• Flap thickness Ziemer LDV:

  –   LDV 110 µm separating @ 105 + 7.2 µm
  –   LDV 90 µm separating @ 90.2 + 5.7 µm
  –   LDV 100 µm separating @ 96.3 + 9 µm
  –   Working at “Five sigma”
  –   Small Bubble technology allows thinner
      flaps while avoiding inflammation

                                UNIVERSITY OF ROCHESTER

				
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