Comparison of Intracorneal Inlay for Presbyopia Correction: Hydrogel and Small-Aperture Inlays with a Six- Months Follow-Up

Ji Yun Lee; Ae Ri Yoo; Ju Yeon Lee; Dong Hui Lim; Jae Yong Kim; Myoung Joon Kim; Tae Young Chung; Eui Sang Chung; Hung Won Tchah

doi:10.3341/jkos.2015.56.12.1840

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Lee, Yoo, Lee, Lim, Kim, Kim, Chung, Chung, and Tchah: Comparison of Intracorneal Inlay for Presbyopia Correction: Hydrogel and Small-Aperture Inlays with a Six- Months Follow-Up

Original Article

J Korean Ophthalmol Soc 2015;56(12):1840-1847.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1840

Comparison of Intracorneal Inlay for Presbyopia Correction: Hydrogel and Small-Aperture Inlays with a Six- Months Follow-Up

Ji Yun Lee, M.D¹, Ae Ri Yoo, M.D¹, Ju Yeon Lee, M.D², Dong Hui Lim, M.D², Jae Yong Kim, M.D, PhD¹, Myoung Joon Kim, M.D, PhD¹, Tae Young Chung, M.D, PhD², Eui Sang Chung, M.D, PhD², Hung Won Tchah, M.D, PhD^1,

¹Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine^¹, Seoul, Korea

²Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Hung Won Tchah, MD, PhD Department of Ophthalmology, Asan Medical Center, #88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3674, Fax: 82-2-470-6440 E-mail: hwtchah@amc.seoul.kr

Received 15 May 201522 July 2015 Accepted 28 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To study the safety and efficacy of corneal reshaping and small-aperture inlays and compare the clinical results.

Methods

From February 2014 to November 2014, 22 corneal reshaping inlays were inserted at Asan Medical Center and from October 2012 to March 2013, 26 small-aperture inlay surgeries were performed: 6 eyes at Asan Medical Center and 20 eyes at Samsung Medical Center. The preoperative and postoperative parameters were reviewed retrospectively and included monocu-lar uncorrected distance visual acuity (UDVA; log MAR), uncorrected near visual acuity (UNVA; log MAR), refraction and corneal curvature based on automated refractor keratometry, reading distance and patient satisfaction.

Results

In the hydrogel inlay group, preoperative mean monocular UNVA was 0.83 ± 0.05 and monocular UDVA 0.07 ± 0.03. At 6 months, mean monocular UNVA was 0.23 ± 0.05 and UDVA 0.05 ± 0.02. The most preferred mean reading distance in the hy-drogel inlay group was 39.38 ± 3.18 cm. In the small-aperture inlay group, preoperative mean monocular UNVA was 0.4 ± 0.06 and monocular uncorrected visual acuity 0.27 ± 0.04. At 6 months, mean monocular UNVA was 0.11 ± 0.02 and UDVA 0.09 ±0.05 and the most preferred mean reading distance was 44.23 ± 5.17 cm. Although 85% of patients in the corneal reshaping in-lay group were satisfied or very satisfied, only 20% of patients in the small-aperture inlay group were satisfied.

Conclusions

Both inlays are considered good options for correcting presbyopia. However, postoperative satisfaction score was higher and less glare symptoms were reported in the hydrogel inlay group.

Keywords: Corneal inlay, Corneal reshaping inlay, Presbyopia, Small-aperture inlay

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Figure 1.

Perioperative changes in mean and standard devia-tion of monocular UNVA (log MAR) in surgical eyes over 6 months of follow-up. Preop = preoperative; Postop = post-perative; UNVA = uncorrected near visual acuity. ^* p < 0.05, the comparison with just before the time point.

Figure 2.

Perioperative changes in mean and standard devia-tion of monocular UDVA (log MAR) of surgical eyes over 6 months of follow-up. Preop = preoperative; Postop = post-perative; UDVA = uncorrected distance visual acuity. ^* p < 0.05, the comparison with just before time point.

Figure 3.

Perioperative changes in mean and standard devia-tion of spherical equivalent (diopters) of surgical eyes over 6 months of follow-up. Preop = preoperative; Postop = post-perative; MRSE = manifest refraction spherical equivalent. ^* KAMRA data obtained from only Asan Medical Center (total 6 patients).

Figure 4.

Perioperative changes in mean and standard devia-tion of keratometric values (diopters) of surgical eyes over 6 months of follow-up. Preop = preoperative; Postop = post-perative; K = keratometric reading. ^* KAMRA data obtained from only Asan Medical Center (total 6 patients).

Figure 5.

Perioperative changes in mean and standard devia-tion of preference reading distance (cm) of surgical eyes over 6 months of follow-up. Postop = postoperative. ^* p < 0.05, the comparison with just before time point; ^† KAMRA data ob-tained from only Asan Medical Center (total 6 patients).

Table 1.

Patient demographics and clinical information

Parameter	Raindrop	KAMRA
Eyes (n)	22	26
Patients (n)	22	26
Inlay only:inlay with concurrent LASIK	17:5	11:15
Sex (male:female)	8:14	9:17
Age (years, range)	54.41 ± 4.1 (49-62)	54.03 ± 5.47 (43-64)
Monocular UNVA (log MAR)	0.83 ± 0.05	0.4 ± 0.06
Monocular UDVA (log MAR)	0.07 ± 0.03	0.27 ± 0.04
SE (diopter)	0.39 ± 0.32	-1.13 ± 0.43

Values are presented as mean ± SD unless otherwise indicated. LASIK = laser-assisted in-situ keratomileusis; UNVA = uncorrected near visual acuity; UDVA = uncorrected distant visual acuity; SE= spherical equivalent.

Table 2.

Results of the questionnaires of satisfaction after the operation at 6 months postoperatively

	Raindrop	KAMRA^*
Overall satisfaction	3.91 ± 1.1	2.71 ± 1.1
Near glasses dependency	2.45 ± 0.8	2.40 ± 0.55
Glare	2.41 ± 0.9	3.48 ± 0.67
Glare at night or dark place	2.33 ± 0.9	2.88 ± 0.8

Values are presented as mean ± SD.^* Data obtained from only Asan Medical Center (total 6 patients).

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