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H. Goyal, S. C. Belmont; Laser Assisted Presbyopia Reversal - A 5 Year Follow-Up Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2805.
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To report the long term success of Laser-Assisted Presbyopia Reversal
LAPR is a procedure in which an Erbium laser is applied through a fiberoptic probe to create 8 scleral incisions in a radial pattern, 2 incisions in each quadrant of the eye. The procedure is performed under topical anesthesia. The conjunctiva is opened mechanically, cautery is used for hemostasis. Each scleral incision is 0.5 mm from the limbus, 2.5mm long, and 400-500 microns deep using blue choroidal hue as an end point. We had a total of 12 patients during our clinical trials in 2003 - 5 females, 7 males, with ages ranging from 50 to 65. Amplitude of accommodation was measured by the blur method pre-op, post-op 1 day, 2 weeks, 3 and 6 months, 1, 2, and 5 years. In this study, we will report results from 6 months to 5 years.
In the initial 6 month post-operative period there was an increase in diopters of accommodation (DA) in all patients and an improvement in uncorrected near visual acuity (NVA) in 11 of 12 patients. Pre-operative DA averaged 1.58 and NVA Jaeger standard 8.3 for all 12 patients. Six months post-op, the average DA was 3.61 and NVA was 2.8 for the 9 patients that came for follow-up. One year post-procedure DA and NVA were 3.25 and 3.5, respectively, for 5 patients. At 2 years, average DA and NVA were 2.6 and 3.0 for 4 patients. Only 2 patients came for examination at 5 years. Their DA and NVA averaged 1.75 and 4.5. Of the 10 remaining patients who did not follow-up 5 years post-op, 1 patient passed away 2 years after surgery, 1 had monovision PRK 3 years after LAPR, and 8 were either unhappy with the results of the procedure or unreachable. Distance vision remained unchanged in all patients throughout the study. There were no major complications such as ocular hypotony, filtering blebs, scleral perforation, or infection.
Current literature suggests LAPR is successful in reversing presbyopia up to 18 months post-op. However, there are no long term studies published. Due to limited patient enrollment and follow-up we cannot make any conclusive statements concerning the efficacy of the LAPR procedure.
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