June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Methods and Design to Reduce Cyclotorsion and Decentration Error for Lenticule Extraction Surgery with a Next-Generation Femtosecond Laser System
Author Affiliations & Notes
  • Andrew P Voorhees
    Research and Development, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • Li Chen
    Research and Development, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • Deepali Mehta-Hurt
    Research and Development, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • Sanjeev Kasthurirangan
    Clinical Science, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • Michal Laron
    Clinical Science, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • ying yu
    Research and Development, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • Hong Fu
    Research and Development, Johnson & Johnson Surgical Vision, Milpitas, California, United States
  • Footnotes
    Commercial Relationships   Andrew Voorhees, Johnson & Johnson (E), Johnson & Johnson (P); Li Chen, Johnson & Johnson (E), Johnson & Johnson (P); Deepali Mehta-Hurt, Johnson & Johnson (E), Johnson & Johnson (P); Sanjeev Kasthurirangan, Johnson & Johnson (E); Michal Laron, Johnson & Johnson (E); ying yu, Johnson & Johnson (E), Johnson & Johnson (P); Hong Fu, Johnson & Johnson (E), Johnson & Johnson (P)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3593. doi:
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      Andrew P Voorhees, Li Chen, Deepali Mehta-Hurt, Sanjeev Kasthurirangan, Michal Laron, ying yu, Hong Fu; Methods and Design to Reduce Cyclotorsion and Decentration Error for Lenticule Extraction Surgery with a Next-Generation Femtosecond Laser System. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3593.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We are currently developing a next-generation femtosecond laser with lenticule extraction capability. Our new system allows for treatment centration and cyclotorsion corrections to be made through software after applanation. The goal of this clinical study was to evaluate corneal marking procedures to assist surgeons in identifying the treatment center and axis.

Methods : In total, 79 subjects were enrolled and 1 eye from each subject was tested. We tested 2 corneal axis markers for creating reference gentian violet ink marks at 8 mm diameter on the subject’s nasal-temporal axis while seated upright: Surgilum Robomarker (SR) and Duckworth and Kent OTA Reference Marker for Intrascleral Fixation (D&K). After marking the study eye, the subject was positioned and leveled behind a slit lamp and an image of the eye was taken and image analysis performed to determine marking accuracy. A 0.5 mm spherical tipped Ogawa Hook was used to place a gentian violet ink mark on the pupil center. Subject was then transferred under our laser system and images of the marked eye were taken before applanation with the eye fixating on a coaxial target and again after applanation. Image analysis was done to estimate the decentration error expected if the surgeon had been instructed to: Center treatment on the central corneal mark (Method M1);Center treatment on the apparent applanated pupil center (Method M2); Leave the treatment centered on the center of the patient interface (Method M3). Results are reported as (mean±SD; range; n) and significant differences were tested with Bonferroni corrected t-tests.

Results : The absolute error in the surgeon’s placement of the axis marks for SR was (3.7°±2.5°; 0°-11°; n=45) and (2.9°±1.9°; 0°-8°; n=30) for D&K, however the difference was not statistically significant (p=0.069). There were no statistical differences between left and right eyes. The centration error was (332±152um; 47-561um; n=25) for M1, (329±165um; 38-690um; n=25) for M2, and (578±263um; 64-1007um; n=25) for M3. The error for M1 and M2 were not significantly different (p=0.947), but the error for M3 was significantly higher than both M1 and M2 (p<0.01).

Conclusions : Giving surgeons the ability to recenter lenticule treatment through software will significantly alleviate refractive treatment decentration error and should alleviate induced coma.

This is a 2020 ARVO Annual Meeting abstract.

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