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Effects of IOP Lowering Agents on Myopic Regression after Refractive
Surgery
Lim, Taehyung M.D., Hong, So Jin M.D., Cho, Beom Jin M.D., Ph.D.
Chung Kyu-Hyung M.D, Ph.D, Choi Kee-Yong M.D, Ph.D.
HanGil Eye Hospital
* All authors have no financial interest in the subject matter of this poster.
BackgroundBackground
The higher IOP, the more anterior shifting of the cornea
Factors affecting the forward shift of posterior corneal surface after laser in situ keratomileusis. Baek T, et al, 108(2):317-20, 2001, Ophthalmology
Factors affecting the forward shift of posterior corneal surface after laser in situ keratomileusis. Baek T, et al, 108(2):317-20, 2001, Ophthalmology
Differences between regressive eyes and non-regressive eyes after LASIK for myopia in the time course of corneal changes assessed with the Orbscan. Pan, et al, 218(2):96-101, 2004, Ophthalmologica
Differences between regressive eyes and non-regressive eyes after LASIK for myopia in the time course of corneal changes assessed with the Orbscan. Pan, et al, 218(2):96-101, 2004, Ophthalmologica
Regressive eye vs. Non-regressive eye differed in the corneal shifting movements after LASIK
Regression-related factors before and after laser in situ keratomileusis. Qi H. et al, 220(4):272-6,2006 Ophthalmologica
Regression-related factors before and after laser in situ keratomileusis. Qi H. et al, 220(4):272-6,2006 Ophthalmologica
IOP lowering may prevent myopic regression.
Evidences of correlation between IOP and refractive error after LASIK
BackgroundBackground
Effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis.
Kamiya K, et al, 145(2):233-238, Am J Ophthalmol, 2008
Effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis.
Kamiya K, et al, 145(2):233-238, Am J Ophthalmol, 2008
27 eyes with myopic regression after LASIKMean regression : 1.26±0.48D(-0.5 ~ -2.25D)2.5 % Nipradilol bid for 3months
Pretreatment 3 Months
Spherical -1.02±0.52D -0.44±0.39D*
Astigmatism -0.55±0.30D -0.49±0.22D
IOP 11.4±2.4mmHg 9.1±8.2mmHg*
CCT 505.2±39.3um 505.6±38.7um
15% of patients did not respond to the treatment.
Evidences of correlation between IOP and refractive error after LASIK
BackgroundBackground
Pretreatment 3 Months
Mean refractive power of the total cornea
(3mm)38.4±2.0D 37.7±2.0D
Posterior corneal surface shifted posteriorly by 9.1±8.2um (mean)
It is suggested that backward movement of the cornea may occur, possibly flattening the corneal curvature by lowering the IOP
Effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis.
Kamiya K, et al, 145(2):233-238, Am J Ophthalmol, 2008
Effects of antiglaucoma drugs on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis.
Kamiya K, et al, 145(2):233-238, Am J Ophthalmol, 2008
Evidences of correlation between IOP and refractive error after LASIK
PurposePurpose
To evaluate effects of IOP lowering agents on patients who
have myopic regression after laser vision correction(LVC)
MethodsMethods
94 eyes in 47 patients (Male = 11 , Female = 36)
Mean age : 33.7 years (22~53)
Patients who have myopic regression after LVC
Occurrence of Myopic regression after LVC : postoperative 4y5m ± 3y11m (1month ~ 12 years)
Op PRK LASIK LASEK
Number 9 65 20
MethodsMethods
At the time of diagnosis, treatment was started with topical 0.5% timolol + 5% dorsolamide combination (Cosopt®, MSD, USA),twice daily for 3 months.
Outcome parameters :UCVA, BCVA, IOP, CCT, MR, Topography and ACD
f/u period : 1 week, 1 month, 3 months
ResultsResultsPre-
treatmentPost-treatment
1 month Post-treatment
3 months
Spherical error (D)*
-1.02±1.55 -0.50±1.27 -0.41±0.92
Astigmatism (D) -0.23±0.78 -0.18±0.77 -0.18±0.67
IOP(mmHg)* 10.55±5.75 9.17±3.69 9.64±3.78
CCT(um) 486.9±95.1 486.9±95.1 481.6±109.1
ACD(um) 3.23±0.50 3.29±0.61 3.27±0.58
Keratometry(D)†
AnteriorPosterior
39.61±3.77-6.43±0.64
38.36±3.94-6.36±0.51
39.43±3.36-6.41±0.55
* p < 0.05, paired T test for pre-treatment & Post-treatment 3 months† p < 0.05, paired T test for pre-treatment & Post-treatment 1 month
ResultsResults
* Refractive improvement : manifest refraction error (spherical or cylindrical) improvement of more than 0.5D
Refractive Improvement* UCVA improvement
73.3% 87.5 %
Pre-treatment
Post-treatment 1
month
Post-treatment
3 month
UCVA(logMAR)* 0.38±0.51 0.17±0.41 0.15±0.39
BCVA(logMAR) 0.01±0.06 0.01±0.07 0.01±0.08* p < 0.05, paired T test for pre-treatment & Post-treatment 3 months
Refractive error and UCVA changes through 3 months treatment
Pre-Tx Post-Tx 1M Post-Tx 3M
UCVA L
ogM
AR
0.0
0.3
0.6
Change of UCVA(LogMAR)Change of UCVA(LogMAR)
UCVA (LogMAR) improved significantly through 3 months treatment.(p<0.05)
ConclusionConclusion
• UCVA improved in 87.5% of patients much more than that of refractive error improvement(73.3%).
• It is suggested that IOP lowering may induce the change of corneal curvature, according to 1-month result.
• IOP lowering agents may be helpful to reduce myopic regression.
DiscussionDiscussion
• Although 3-month result showed no statistically significant change in corneal curvature, it is still though to be important mechanism that IOP lowering may induce the change of corneal curvature.
• Long term follow-up should be needed.
• We stopped the medication at 3 months and are evaluating patients to confirm the effect and mechanism.