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Study evaluates corneal remodeling after presbyopia-correcting inlay implantation concurrent with LASIK
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Myopic or hyperopic eyes implanted with a presbyopia-correcting inlay at the time of LASIK correction have a similar epithelial remodeling response as emmetropic eyes implanted with the same inlay, independent of the type of refractive error, according to a study.
Corneal inlays are implanted in the nondominant eye to correct presbyopia. Their shape and volume reshape the corneal stroma, which causes the epithelium to rise. Over time, epithelial remodeling occurs as epithelial cells naturally redistribute away from the center. The initial rise is reduced to approximately 10 µm, tapering toward the periphery. As a result, a new profocal addition power profile is created, which effectively corrects presbyopia.
The study was aimed at assessing whether a similar epithelial remodeling occurs when the inlay is placed under a LASIK flap in eyes that need concurrent refractive error correction. Thirty-four hyperopic patients and 29 myopic patients were included in a retrospective analysis. They all had undergone femtosecond-assisted LASIK, and a Raindrop near vision inlay (ReVision Optics) had been placed under the LASIK flap in the nondominant eye.
Visual acuity results were similar in the two refractive groups. Both groups had similar near and distance performance. At the center of the inlay, hyperopic eyes had a slightly higher induced add power as compared with myopic eyes. The epithelial thinning profiles at 6 months were not significantly different between the two groups, and the thinning was likely not a function of the amount of hyperopic or myopic treatment.
The clinical and remodeling response in eyes with inlays plus LASIK was overall similar to the response of emmetropic eyes implanted with the inlay alone, as assessed in a previous study by the authors.
“Inlays represent a new option for the secondary management of accommodation loss after a previous surgery, like cataract with monofocal implantation or of presbyopia occurring after LASIK,” Béatrice Cochener, MD, PhD, one of the study authors, told Ocular Surgery News. “They can be even added in single step as a concurrent procedure, for surgeons who like the idea of a reversible option. The Raindrop lenticule offers the interest of asphericity modulation less sensitive to perfect centration and allows a relatively more superficial implantation. However, whatever the concept, a long follow-up is recommended to evaluate the long-term stability and corneal biotolerance.” – by Michela Cimberle
Disclosures: Steinert was a consultant to ReVision Optics. Cochener reports she is a consultant to ReVision Optics. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Francesco Carones, MD
This study shows that the refractive outcomes and epithelial remodeling induced by the Raindrop presbyopia-correcting inlay are not influenced by previous hyperopic or myopic excimer laser treatment with LASIK, at least for the range of corrections performed. These findings expand the indications of this inlay to myopic and hyperopic patients who want to correct their preexisting refractive error and be less dependent on reading glasses when they are in the presbyopic age. Maybe, expanding the range of attempted corrections both in the myopic and in the hyperopic side would further expand the indications.
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