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1、1Combined wavefront and topography guided treatment with the new CRS Master November 2006Carl Zeiss MeditecJoachim Fiedler2Clinical settingsEarly clinical study with new TOSCA II algorithmTopography-guided treatment of selected repair cases in 2 locationsRepair cases forSmall optical zoneDecentred a

2、blationIrregular astigmatismUp to 6 month follow upPre/post op comparison of wavefront dataCases by Dr. Goes, AntwerpCases by Dan Z. Reinstein, London3Study site Dr. GoesAll patients had LASIKFlap re-lift for enhancementBEFOREAFTER 20/20020/2013Study site Dr. ReinsteinMost cases done in PRK on top o

3、f the previous flapFollow up between 2 and 6 monthsDZ Reinstein Case 1: Complaints Halos, Starbursts, GhostDZ Reinstein Case 1: Case HistoryPre Op -2.75 Sphere LASIK in 2001Post Op OS Manifest+1.25 -2.50 x 100 BSCVA 20/16 UCVA 20/32 Scarring: Thin flap? Buttonhole? Cryptic buttonhole Night vision di

4、sturbancesDZ Reinstein Case 1: Case HistoryRepair Treatments1. Ultrasound guided PTK for scar removal2. Topography guided PRK for night vision correctionDZ Reinstein Case 1: Pre-TOSCA II Exam 32 yo white maleManifestBSCVAUCVAPre PRK-0.50 -0.25 x 520/1620/16Intended-0.25 sphDZ Reinstein Case 1: Pre-T

5、OSCA II ExamComa1.59 mSph Ab-4.84 mHO RMS0.46 mDZ Reinstein Case 1: TOSCA II Treatment PlanDZ Reinstein Case 1: Post-TOSCA II ExamManifestBSCVAUCVAPre PRK-0.50 -0.25 x 520/1620/16Intended-0.25 sph1 Week0.00 -0.25 x 2020/1620/161 Month0.00 -0.50 x 1020/1620/16DZ Reinstein Case 1: Topography Differenc

6、e 1 MonthDZ Reinstein Case 1: Wavefront Difference 1 MonthComa1.59 mSph Ab-4.84 mHO RMS0.46 mComa2.06 mSph Ab-2.26 mHO RMS0.41 mDZ Reinstein Case 2: Complaints Dryness ?ABMD Night vision problems & blurriness Halo, blurring not improved by lensDZ Reinstein Case 2: Case HistoryPre Op -8.00 Sphere

7、 LASIK in 1998: LADARvision, Hansatome 180Post Op Manifest+0.75 -1.25 x 5 Enhancement in 1999Post Enh Manifest+0.25 -0.25 x 40 BSCVA20/20 UCVA20/20DZ Reinstein Case 2: Pre-TOSCA II Exam 32 yo white maleManifestBSCVAUCVAPre PRK+0.25 -0.25 x 3320/2020/20IntendedplanoDZ Reinstein Case 2: Pre-TOSCA II E

8、xamComa4.49 mSph Ab-7.73 mHO RMS0.89 mDZ Reinstein Case 2: TOSCA II Treatment PlanDZ Reinstein Case 2: TOSCA II Treatment PlanDZ Reinstein Case 2: Post-TOSCA II ExamManifestBSCVAUCVAPre PRK+0.25 -0.25 x 3320/2020/20Intendedplano1 Week-1.00 -0.25 x 7020/3220/801 Month-1.50 -0.25 x 2720/2520/503 Month

9、0.00 -1.50 x 9220/2020/326 Month+0.50 -0.75 x 6220/1620/16DZ Reinstein Case 2: Topography Over TimePre Op6 Months2 Months1 Month1 Week4 MonthsDZ Reinstein Case 2: Wavefront Difference 1 MonthComa4.34 mSph Ab-7.91 mHO RMS0.88 mComa4.58 mSph Ab0.16 mHO RMS0.62 mDZ Reinstein Case 2: Wavefront Differenc

10、e 3 MonthsComa4.34 mSph Ab-7.91 mHO RMS0.88 mComa1.76 mSph Ab-1.56 mHO RMS0.29 mDZ Reinstein Case 2: Wavefront Difference 6 MonthsComa4.34 mSph Ab-7.91 mHO RMS0.88 mComa2.82 mSph Ab-3.17 mHO RMS0.50 mDZ Reinstein Case 5: Case HistoryCase History LASIK OU in 1997 Moria LSK-One/Nidek EC5000 History of

11、 multiple images OSComplaints Night vision disturbances +DZ Reinstein Case 5: Pre-TOSCA II ExamManifestBSCVAUCVAPre PRK+0.50 -0.25 x 10620/1620/16IntendedplanoComa4.65 mSph Ab-7.60 mHO RMS0.81 mDZ Reinstein Case 5: Topography Difference 2 MonthsDZ Reinstein Case 5: Post-TOSCA II ExamManifestBSCVAUCV

12、APre PRK+0.50 -0.25 x 10620/1620/16Intendedplano1 Weekplano20/2020/202 Months+0.25 -0.25 x 18020/1620/16DZ Reinstein Case 5: Wavefront Difference 1 WeekComa4.65 mSph Ab-7.60 mHO RMS0.81 mComa5.82 mSph Ab-2.58 mHO RMS0.78 mDZ Reinstein Case 5: Wavefront Difference 6 MonthsComa4.65 mSph Ab-7.60 mHO RM

13、S0.81 mComa1.24 mSph Ab-6.15 mHO RMS0.49 mDZ Reinstein Case 13: Pre-TOSCA II ExamManifestBSCVAUCVAPre PRK-0.25 -1.00 x 12420/2520/50Intended-1.50 sphComa6.38 mSph Ab-3.21 mHO RMS0.91 mDZ Reinstein Case 13: Topography Difference 5 MonthDZ Reinstein Case 13: Post-TOSCA II ExamManifestBSCVAUCVAPre PRK-

14、0.25 -1.00 x 12420/2520/50Intended-1.50 sph1 Week-1.75 -0.50 x 8020/3220/1251 Month-0.75 sph20/2020/323 Months-0.75 sph20/2520/255 Months+0.00 -1.00 x 3520/2020/40DZ Reinstein Case 13: Wavefront Difference 5 MonthsComa6.38 mSph Ab-3.21 mHO RMS0.91 mComa3.65 mSph Ab-3.00 mHO RMS0.73 mDZ Reinstein Top

15、ography Treatments - SafetyFollow up for PRK cases 1 month onlyDZ Reinstein Topography Treatments - AccuracyDZ Reinstein Higher Order RMS All EyesReduced 17%Average HO RMS Before & After TOSCA II TreatmentSignificantDZ Reinstein Spherical Aberration (Seidel) All EyesReduced 28%Average Spherical Aberration Before & After TOSCA II TreatmentSignificant48ConclusionsTopography guided enhancements are safe and effective (29 eyes)Improved the patient situation in most of cases, none became worse V