Intracorneal inlay to correct presbyopia: Long‐term results

PURPOSE: To evaluate the long‐term visual results of Acufocus ACI‐7000 (now Kamra) intracorneal inlay implantation in presbyopic phakic patients. SETTING: Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Clinical trial. METHODS: This study comprised patients with emmetropic or post‐laser in situ keratomileusis (LASIK) presbyopia. Patients had an uncorrected near visual acuity (UNVA) of 20/40 or worse, correctable to 20/25 or better at distance. The inlay was implanted on the stromal bed after the LASIK flap was relifted or a flap created. The inlay was centered on the presurgical position of the first Purkinje reflex. The main outcome measures were distance and near vision and the complication rate. RESULTS: The study enrolled 39 patients aged 45 to 60 years. At the 4‐year follow‐up, all patients (N = 22) had 2 or more lines of improvement in UNVA with no significant loss in distance vision. The mean final UNVA was 20/20 (Jaeger [J1]); 96% of patients could read J3 or better. The uncorrected distance acuity was 20/40 or better in all eyes. Five patients had cataract progression, and 2 had a change in refractive status. No eye with an intracorneal inlay had intraoperative complications during cataract extraction. Four inlays were explanted during the study. There were no severe corneal complications that affected final vision. CONCLUSION: Intracorneal inlay implantation was an effective, safe, and reversible procedure for the long‐term surgical treatment of presbyopia. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

[1]  K. Gerstmeyer,et al.  Long-term results of the foldable CeeOn Edge intraocular lens. , 2000, Journal of cataract and refractive surgery.

[2]  S. Wilson Laser in situ keratomileusis-induced (presumed) neurotrophic epitheliopathy. , 2001, Ophthalmology.

[3]  D. Panescu Conductive keratoplasty. , 2004, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[4]  D. Azar,et al.  Conductive Keratoplasty , 2004, International ophthalmology clinics.

[5]  G. Baïkoff,et al.  Correction of presbyopia with refractive multifocal phakic intraocular lenses , 2004, Journal of cataract and refractive surgery.

[6]  Corina van de Pol,et al.  Intracorneal inlay for the surgical correction of presbyopia , 2008, Journal of cataract and refractive surgery.

[7]  R. Ambrósio,et al.  Laser in situ keratomileusis-induced neurotrophic epitheliopathy. , 2001, American journal of ophthalmology.

[8]  S. Lane,et al.  Polysulfone Intracorneal Lenses , 1985, International ophthalmology clinics.

[9]  R. Ambrósio,et al.  LASIK-associated dry eye and neurotrophic epitheliopathy: pathophysiology and strategies for prevention and treatment. , 2008, Journal of refractive surgery.

[10]  R. Beuerman,et al.  The role of the lacrimal functional unit in the pathophysiology of dry eye. , 2004, Experimental eye research.

[11]  F G Holz,et al.  [PresbyLASIK: treatment approaches with the excimer laser]. , 2006, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.

[12]  D. Azar,et al.  Physiological optics for keratorefractive surgery , 2007 .

[13]  S. Pflugfelder,et al.  Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface. , 2001, Ophthalmology.

[14]  W. Charman The eye in focus: accommodation and presbyopia , 2008, Clinical & experimental optometry.

[15]  P. Büchler,et al.  Oxygen and Glucose Distribution After Intracorneal Lens Implantation , 2007, Optometry and vision science : official publication of the American Academy of Optometry.

[16]  Adrian Glasser,et al.  Restoration of accommodation: surgical options for correction of presbyopia , 2008, Clinical & experimental optometry.

[17]  W. Knowles Effect of intralamellar plastic membranes on corneal physiology. , 1961, American journal of ophthalmology.

[18]  T. Kohnen,et al.  Akkommodation und Presbyopie , 2008, Der Ophthalmologe.

[19]  G. Waring,et al.  Polysulfone corneal lenses , 1986, Journal of cataract and refractive surgery.

[20]  D L Guyton,et al.  Centering corneal surgical procedures. , 1987, American journal of ophthalmology.

[21]  Presbyopia: perspective on the reality of pseudoaccommodation with LASIK. , 2006, Ophthalmology clinics of North America.

[22]  H. Kawakami,et al.  Biocompatibility of fluorinated polyimide. , 2002, Journal of biomedical materials research.

[23]  T. Kohnen,et al.  [Accommodation and presbyopia : part 2: surgical procedures for the correction of presbyopia]. , 2008, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.