Analysis of Visual Outcomes and Small Aperture Corneal Inlay Position after Implantation with Simultaneous LASIK for Correction of Presbyopia.　

1. Minoru Tomita, MD, PhD
2. Mitsutoshi Ito, MD, PhD
3. Satoshi Yukawa, MD
4. Keigo Sekiya, MD, PhD
5. Takahiro Yamamoto, MD
6. Tadahiko Tsuru, MD, PhD

Shinagawa LASIK Center, Tokyo, Japan

Purpose:
To evaluate the effects of deviation of the Kamra inlay (AcuFocus) from the first Purkinje image on visual acuities after simultaneous treatment of presbyopia and refractive errors. The degree of decentration of the inlay was determined using Kamra AcuTarget (SensoMotoric Instruments).

Methods:
From September 2009 to September 2010, 316 patients underwent simultaneous Kamra inlay implantation and either unilateral or bilateral LASIK to treat presbyopia. The Kamra inlay was implanted immediately after LASIK in the non-dominant eye. Deviations of the inlay from the first Purkinje image were determined using Kamra AcuTarget at 1 month postoperative. The patients were classified into Group A (decentration within 100μm) and Group B (decentration over 100μm). The correlations between the decentration of the inlays and uncorrected near visual acuity (UNVA, at 30cm) or uncorrected distance visual acuity (UDVA) of the inlay-implanted eyes were evaluated at 3 months postoperative.

Results:
At 3 months after surgery, the percentage of inlay eyes with UNVA J3 or better was 83% in Group A and 67% in Group B. The percentage of eyes with UDVA 20/20 or better was 67% in Group A and 59% in Group B. (Mean UDVA is 20/22 and 20/21, respectively). Both UNVA and UDVA were better with less decentration of Kamra inlays.

Conclusions:
Decentration of the Kamra inlay affects both near and distance visual outcomes after simultaneous inlay implantation and LASIK. The Kamra AcuTarget may be useful in detecting decentration of intracorneal inlays and improving visual outcomes in the treatment of presbyopia in emmetropoic, hyperopic, and myopic patients.