ΠΕΤΡΟΣ ΣΜΑΧΛΙΟΥ FRCS FEBO

 ΑΣΦΑΛΕΙΑ  ΟΧΙ ΚΑΛΗ ΕΠΑΝΑΛΗΨΙΜΟΤΗΤΑ  AΡΓΗ ΕΠΕΜΒΑΣΗ  ΠΟΝΟΣ  HAZE  ΥΠΕΡΔΟΣΟΛΟΓΙΑ  ΔΥΣΑΝΕΞΙΑ ΣΤΟΥΣ ΦΑΚΟΥΣ ΕΠΑΦΗΣ  ΑΡΓΗ ΕΠΟΥΛΩΣΗ  ‘ΟΡΙΑΚΑ΄ ΠΕΡΙΣΤΑΤΙΚΑ

 AΠΟΞΕΣΗ ΕΠΙΘΗΛΙΟΥ 9,00χιλ.  ΡΙΒΟΦΛΑΒΙΝΗ 0,1% ΚΑΘΕ 3 ΛΕΠΤΑ ΓΙΑ ΜΙΣΗ ΩΡΑ  ΑΚΤΙΝΟΒΟΛΗΣΗ ΓΙΑ 30 ΛΕΠΤΑ ΒΑΖΟΝΤΑΣ ΡIBOFLABINH ΚΑΘΕ 3 ΛΕΠΤΑ  ΦΑΚΟΣ ΕΠΑΦΗΣ  ΣΤΑΓΟΝΕΣ ΚΟΡΤΙΖΟΝΗΣ ΚΑΙ ΑΝΤΙΒΙΟΤΙΚΟΥ

 ΕΙΝΑΙ ΑΣΦΑΛΗΣ (ενδοθηλιο, κερατοκυτταρα, φακος κα)  ΕΙΝΑΙ ΓΡΗΓΟΡΗ  ΕΙΝΑΙ ΑΠΟΤΕΛΕΣΜΑΤΙΚΗ (και σε βαθος χρονου)  ΕΧΕΙ ΕΠΑΝΑΛΗΨΙΜΟΤΗΤΑ (ειναι στανταρισμενη)  ΔΕΝ ΕΧΕΙ ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΠΡΟΒΛΗΜΑΤΑ

SpeedSpeed Typical UVA Light source in current use Avedro KXL System 3 mW/cm 2 30 min exposure 30 mW/cm 2 3 min exposure 5J/cm 2 Same Energy on Cornea MA-00057, Rev. A

Keratocyte and Endothelial Cell Viability Endothelial cells show similar or better cell viability at higher irradiance for shorter time vs. lower irradiance for a longer time SafetySafety Courtesy of Prof. John Marshall 3mW/cm 2 – 30 Min 30mW/cm 2 – 3 Min *Optical Density MA-00057, Rev. A

 ΔΟ : -2,00 / -1,25 x 103  AO: -1,50 / -1,50 x 75  Παχυμετρία : 550μ, αμφω

 ΔΕΞΙ ΜΑΤΙ : transepithelial PRK & PRK-Xtra  ΑΡΙΣΤΕΡΟ ΜΑΤΙ :transepithelial topoguited PRK& AVEDRO CXL

Lasik (PRK) Xtra …Strengthening Corneas Weakened by Lasik (or PRK) 9 Efficacy:Lasik Xtra returns corneas to their original pre-surgical strength Speed: 1.25 minute UVA exposure with higher power Safety: 1 minute soak time Predictability: Uniform Beam Profile MA-00057, Rev. A

High performance Cross-linking Protocol: Keratoconus & Post-Lasik Ectasia Speed: Accelerated 3 minute UVA exposure at 30 mW/cm 2 Safety: 5-10 minute time soak time (depending on corneal thickness) Predictability: Uniform beam profile (Consistent energy delivered across the cornea with superior depth of focus) MA-00057, Rev. A

Corneal Biomechanics Corneal Young’s Modulus/MPa SpeedSpeed Courtesy of Prof. John Marshall MA-00057, Rev. A UVA Cross-linked 30 mW/cm² Avedro Others UVA Cross-linked 3 mW/cm²

 ΔΕΞΙΟΣ ΟΦΘΑΛΜΟΣ: +0,25 / - 0,50Χ 140  ΑΡΙΣΤΕΡΟΣ ΟΦΘΑΛΜΟΣ: +0,25  BCVA: 20/20 BEs

A Lasik Flap Weakens the Cornea by up to 30% Courtesy of Prof. John Marshall Flap Depth Corneal Weakening MA-00057, Rev. A

Equi-dose Extensiometry: Stress/Strain There are no statistically significant biomechanical differences when Equi-dosing high UVA with shorter exposure time Adapted from Krueger, Spoerl, Herekar, Rapid vs. Standard Collagen CXL with Equivalent Energy Dosing. Original online presentation link: linking SpeedSpeed MA-00057, Rev. A

Endothelium Safety Concerns are Related to … UVA & Riboflavin Interaction, NOT UVA Alone SafetySafety Two important considerations when performing cross-linking: 1.Have enough riboflavin in the anterior stroma for cross-link formation 2. Limit the UVA absorption by the riboflavin adjacent to the endothelium KXL accelerated crosslinking at μm has the same relative absorption as standard cross- linking at μm CXL: 30 minute pre-soak; 30 minute 3 mW/cm ² KXL: 5 minute pre-soak; 3 minute 30 mW/cm ² KXL: 10 minute pre-soak; 3 minute 30 mW/cm ² MA-00057, Rev. A

PredictabilityPredictability 9 mm Aperture Bowman’s Endothelium 3 mW/cm 2 typical UVA light in current use Cool edges provide no cross-linking Center to edge beam uniformity insures consistent results 30 mW/cm 2 KXL System MA-00057, Rev. A

Current Standard of Care: Ophthalmologists perform negative prophylaxis by rejecting some % of lasik patients Positive Prophylaxis is Possible With Lasik Xtra Ineligible for Lasik due to potential corneal weakness All potential patients who desire Lasik With Lasik Xtra: Because cross-linking increases corneal strength, positive prophylaxis with cross-linking can make many of these patients eligible for Lasik Ineligible Eligible EfficacyEfficacy MA-00057, Rev. A

 ΤΟ KXL EINAI ENA KAINOYΡΓΙΟ ‘ΕΡΓΑΛΕΙΟ’ ΣΤΑ ΧΕΡΙΑ ΤΟΥ ΚΛΙΝΙΚΟΥ ΟΦΘΑΛΜΙΑΤΡΟΥ  ΥΠΟΣΧΕΤΑΙ ΜΕΓΑΛΥΤΕΡΗ ΑΣΦΑΛΕΙΑ  ΚΑΛΥΤΕΡΗ ΕΠΑΝΑΛΗΨΙΜΟΤΗΤΑ  ΤΟ LASIK Xtra ΠΡΟΣΦΕΡΕΙ ΜΕΓΑΛΥΤΕΡΗ ΑΣΦΑΛΕΙΑ ΣΕ ΟΡΙΑΚΕΣ ΠΕΡΙΠΤΩΣΕΙΣ  ΜΕΤΑΤΡΕΠΕΙ CAN’T DO ΠΕΡΙΠΤΩΣΕΙΣ ΣΕ CAN DO  ΕΙΝΑΙ ‘ΒΟΛΙΚΟ’ ΓΙΑΤΙ ΕΙΝΑΙ ΓΡΗΓΟΡΟ  ΕΧΕΙ ΚΑΛΗ ΕΡΓΟΝΟΜΙΑ ΑΛΛΑ ΜΟΝΟ Ο ΧΡΟΝΟΣ ΘΑ ΔΕΙΞΕΙ