Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head id="Head1"><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://www.healio.com:80/ophthalmology/journals/JRS/%7B244C319E-3C4E-423C-A440-568C86F8EBBD%7D/Improved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation","20130816061200","https://web.archive.org/","web","/_static/", "1376633520"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <meta http-equiv="Content-Type" content="text/html; charset=utf-8"/><title> Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation | Journal of Refractive Surgery </title>  <meta name="google-site-verification" content="TCYGZWR7Qscjc3GO_imiutAfXMSCFLpchm8rXzIk-5M"/><meta name="msvalidate.01" content="AB0F11E889D663098DB556BB5ACBB719"/><meta id="metaDescription" name="description" content="Journal of Refractive Surgery | PURPOSE:To demonstrate improved effectiveness of transepithelial phototherapeutic keratectomy (PTK) where topography-guided ablation is degraded by epithelial compensation for localized irregularities.METHODS:Artemis very high-frequency digital ultrasound (ArcScan Inc., Morrison, CO) scanning was performed on five eyes (four patients) after LASIK in which a truncated nasal flap was created but "/><meta id="metaKeywords" name="keywords" content="Journal of Refractive Surgery,Ophthalmology,Refractive Surgery,Optics,Original Article"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="PostedDate" content="2013-08-01"/> <meta name="specialties" content="Ophthalmology"/> <meta name="specialty" content="Ophthalmology"/> <meta name="primary_specialty" content="Ophthalmology"/> <meta name="subspecialties" content="Refractive Surgery,Optics"/> <meta name="subspecialty" content="Refractive Surgery"/> <meta name="subspecialty" content="Optics"/> <meta name="departments" content="Original Article"/> <meta name="department" content="Original Article"/> <meta name="content_type" content="Journal Article"/> <meta name="pageid" content="{244C319E-3C4E-423C-A440-568C86F8EBBD}"/> <meta property="og:image" content="https://web.archive.org/web/20130816061200im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/healio_safe_image.png"/><meta name="pubabbv" content="JRS"/><meta name="authors" content="Dan Z. Reinstein MD MA(Cantab) FRCOphth, Timothy J. Archer MA(Oxon) DipCompSci(Cantab), Marine Gobbe MST(Optom) PhD"/><meta name="articleid" content="{244C319E-3C4E-423C-A440-568C86F8EBBD}"/><meta name="legacyarticleid" content=""/><meta name="article-title" content="Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation"/><meta name="article-link" content="/ophthalmology/journals/JRS/{244C319E-3C4E-423C-A440-568C86F8EBBD}/Improved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation"/><meta name="doi" content="10.3928/1081597X-20130719-02"/><meta name="pubname" content="Journal of Refractive Surgery"/><meta name="pubtype" content="print"/><meta name="author" content="Dan Z. Reinstein, MD, MA(Cantab), FRCOphth"/><meta name="author" content=" Timothy J. 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"/> 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href="/web/20130816061200/http://www.healio.com/ophthalmology"> Ophthalmology</a> <span>›</span> <a href="/web/20130816061200/http://www.healio.com/ophthalmology/journals"> Journals</a> <span>›</span> <a href="/web/20130816061200/http://www.healio.com/ophthalmology/journals/jrs"> Journal of Refractive Surgery</a> </p>    <div id="SeeAlso" class="related-links"><h3>See Also</h3><ul><li><a href="https://web.archive.org/web/20130816061200/http://www.healio.com/ophthalmology/journals/jrs/%7B1c1c3bf0-2ba1-43e3-81c1-5a68bc6c90b9%7D/sd-oct-analysis-of-regional-epithelial-thickness-profiles-in-keratoconus-postoperative-corneal-ectasia-and-normal-eyes">SD-OCT Analysis of Regional Epithelial Thickness Profiles in ...</a></li><li><a href="https://web.archive.org/web/20130816061200/http://www.healio.com/ophthalmology/journals/jrs/%7B7628f1f6-f9ec-4d63-bf58-72430df1572b%7D/localized-changes-in-stromal-reflectivity-after-corneal-collagen-cross-linking-observed-with-different-imaging-techniques">Localized Changes in Stromal Reflectivity After Corneal ...</a></li><li><a href="https://web.archive.org/web/20130816061200/http://www.healio.com/ophthalmology/journals/jrs/%7Ba3ac842c-0810-44e1-894f-6ec9f3cf3af5%7D/topography-guided-transepithelial-prk-after-intracorneal-ring-segments-implantation-and-corneal-collagen-cxl-in-a-three-step-procedure-for-keratoconus">Topography-guided Transepithelial PRK After Intracorneal ...</a></li></ul></div> <div class="journals-content"><div class="journal-tab-group"><ul class="journal-tabs"><li><a href="/web/20130816061200/http://www.healio.com/journals/jrs">Current Issue</a></li><li><a href="/web/20130816061200/http://www.healio.com/journals/jrs/m/oar">Online Advanced Release</a></li><li><a href="/web/20130816061200/http://www.healio.com/journals/jrs/m/past-issues">Past Issues</a></li></ul><div class="journal-panes"><div class="abstract-content"><p class="kicker-top">Original Article </p><span class="video-icon"><img src="https://web.archive.org/web/20130816061200im_/http://c341132.r32.cf1.rackcdn.com/VideoIcon.gif" border="0"></img></span><h2><a href="#">Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation</a></h2><p class="authors">Dan Z. Reinstein, MD, MA(Cantab), FRCOphth; Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Marine Gobbe, MST(Optom), PhD</p><div class="journal-info"><ul class="full-text"><li class="header">Read Full Text Article</li><li class="html"><a class="active" title="View Html Version" alt="View Html Version" rel="nofollow" href="/web/20130816061200/http://www.healio.com/buy-journal-or-article?a={244C319E-3C4E-423C-A440-568C86F8EBBD}&amp;returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b244C319E-3C4E-423C-A440-568C86F8EBBD%7d%2fImproved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation&amp;jrnl=J0361">Html Icon</a></li><li class="pdf"><a id="pdf" href="/web/20130816061200/http://www.healio.com/buy-journal-or-article?a={244C319E-3C4E-423C-A440-568C86F8EBBD}&amp;returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b244C319E-3C4E-423C-A440-568C86F8EBBD%7d%2fImproved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation'%3Fpdf%3D1'&amp;jrnl=J0361" class="active" title="View Pdf Version" alt="View Pdf Version" rel="nofollow">Pdf Icon</a></li></ul><ul class="article-citation"><li>Journal of Refractive Surgery</li><li>August 2013 - Volume 29 · Issue 8: 526-533</li><li class="doi">DOI: 10.3928/1081597X-20130719-02</li></ul></div><div class="copyrights" style="float:right;"><a onclick="RightsLinkPopUpV2();" href="#"><img alt="Rights and Permissions" title="Rights and Permissions" border="0" src="https://web.archive.org/web/20130816061200im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/request-permissions.gif"></img></a><script type="text/javascript" language="javascript">function RightsLinkPopUpV2() { var location="https://web.archive.org/web/20130816061200/https://s100.copyright.com/AppDispatchServlet?publisherName=slack&publication=1081-597X&contentID=10.3928/1081597X-20130719-02&publicationDate=2013&copyright=Copyright%20%26copy%3B%202013%2C%20Slack%20Inc.&title=Improved%20Effectiveness%20of%20Transepithelial%20PTK%20Versus%20Topography-Guided%20Ablation%20for%20Stromal%20Irregularities%20Masked%20by%20Epithelial%20Compensation&volumeNum=29&issueNum=8&author=Dan%20Z.%20Reinstein%2C%20MD%2C%20MA(Cantab)%2C%20FRCOphth%3B%20Timothy%20J.%20Archer%2C%20MA(Oxon)%2C%20DipCompSci(Cantab)%3B%20Marine%20Gobbe%2C%20MST(Optom)%2C%20PhD%26orderBeanReset%3DTRUE"; window.open(location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); } </script></div><div class="article-tab-group"><ul class="article-tabs"><li><a id="anchor-tab-abstract" href="#">Abstract</a></li><li><a id="anchor-tab-article" href="/web/20130816061200/http://www.healio.com/buy-journal-or-article?a={244C319E-3C4E-423C-A440-568C86F8EBBD}&amp;returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b244C319E-3C4E-423C-A440-568C86F8EBBD%7d%2fImproved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation'%3Ffulltext%3D1'&amp;jrnl=J0361">Article</a></li><li><a id="anchor-tab-figures" href="/web/20130816061200/http://www.healio.com/buy-journal-or-article?a={244C319E-3C4E-423C-A440-568C86F8EBBD}&amp;returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b244C319E-3C4E-423C-A440-568C86F8EBBD%7d%2fImproved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation'%3Ffulltext%3D1'&amp;jrnl=J0361">Figures/Tables</a></li><li class="last"><a id="anchor-tab-refs" href="/web/20130816061200/http://www.healio.com/buy-journal-or-article?a={244C319E-3C4E-423C-A440-568C86F8EBBD}&amp;returnUrl=%2fophthalmology%2fjournals%2fJRS%2f%7b244C319E-3C4E-423C-A440-568C86F8EBBD%7d%2fImproved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation'%3Ffulltext%3D1'&amp;jrnl=J0361">References</a></li><li class="cite-link"><a href="#" onclick="showCitation();">Get Citation</a><script type="text/javascript">function showCitation() {var w = window.open('', '', 'width=400,height=400,resizeable,scrollbars');w.document.write('Reinstein D, Archer T, Gobbe M. Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation. <i>J Refract Surg.</i> 2013; 29: 526-533. doi: 10.3928/1081597X-20130719-02 <a href="https://web.archive.org/web/20130816061200/http://www.healio.com/ophthalmology/journals/JRS/{244C319E-3C4E-423C-A440-568C86F8EBBD}/Improved-Effectiveness-of-Transepithelial-PTK-Versus-Topography-Guided-Ablation-for-Stromal-Irregularities-Masked-by-Epithelial-Compensation">[link]</a>');w.document.close(); }</script></li></ul></div><div id="abstractPortion"><h4>Abstract</h4><div class="ftSection"><span class="ftInlineSubsectionTitle">PURPOSE:</span><p>To demonstrate improved effectiveness of transepithelial phototherapeutic keratectomy (PTK) where topography-guided ablation is degraded by epithelial compensation for localized irregularities.</p></div><div class="ftSection"><span class="ftInlineSubsectionTitle">METHODS:</span><p>Artemis very high-frequency digital ultrasound (ArcScan Inc., Morrison, CO) scanning was performed on five eyes (four patients) after LASIK in which a truncated nasal flap was created but the ablation was still performed, resulting in irregular astigmatism and double vision. The stromal ablation pattern of a transepithelial PTK ablation was modeled and compared to topography-guided ablation simulations. Artemis-assisted transepithelial PTK procedures were performed in three eyes (two patients).</p></div><div class="ftSection"><span class="ftInlineSubsectionTitle">RESULTS:</span><p>In all cases, Artemis very high-frequency digital ultrasound demonstrated a crevice on the stromal surface caused by ablation on the underside of the flap nasally, which had been compensated for by epithelial thickening, thus masking a significant proportion of the stromal surface irregularity from corneal surface topography. The transepithelial PTK ablation pattern appeared logically to reduce the ridge nasal to the crevice, whereas topography-guided ablation patterns demonstrated poor targeting of the stromal ridge. Artemis-assisted transepithelial PTK greatly reduced the stromal irregularity, resulting in smoother epithelium and topography. In one eye, the epithelium had compensated fully for the irregularity and the patient reported 95% subjective improvement. One patient (two eyes) reported little change in visual symptoms despite significant anatomical regularization due to the partial nature of epithelial compensation, demonstrating that multiple procedures may often be required.</p></div><div class="ftSection"><span class="ftInlineSubsectionTitle">CONCLUSION:</span><p>Compensatory epithelial remodeling masks stromal irregularities from the corneal surface, meaning that topography-guided (or wavefront-guided) ablations may not provide an adequate treatment option and may potentially worsen the irregularity. The effectiveness of transepithelial PTK will depend on the proportion of epithelial masking due to remodeling, related to the rate of change of curvature of the stromal surface.</p><p><b>[ <i>J Refract Surg.</i> 2013;29(8):526–533.]</b></p></div><div class="ftAuthorNotes"><p>From London Vision Clinic, London, United Kingdom (DZR, TJA, MG); Department of Ophthalmology, Columbia University Medical Center, New York, New York (DZR); and Centre Hospitalier National d’Ophtalmologie, Paris, France (DZR).</p><p>Dr. Reinstein is a consultant for Carl Zeiss Meditec (Jena, Germany), has a proprietary interest in the Artemis technology (ArcScan Inc., Morrison, Colorado), and is an author of patents related to very high-frequency digital ultrasound administered by the Cornell Center for Technology Enterprise and Commercialization, Ithaca, New York. Preparation in part fulfillment of the requirements for the doctoral thesis of Dr. Reinstein for University of Cambridge.</p><p>The remaining authors have no financial or proprietary interest in the materials presented herein.</p><p><b>AUTHOR CONTRIBUTIONS</b></p><p><i>Study concept and design (DZR, TJA, MG); data collection (DZR, TJA); analysis and interpretation of data (DZR, TJA, MG); drafting of the manuscript (DZR, TJA); critical revision of the manuscript (DZR, MG)</i></p><p>Correspondence: Dan Z. Reinstein, MD, MA(Cantab), FRCOphth, London Vision Clinic, 138 Harley Street, London W1G 7LA, United Kingdom. E-mail: dzr@londonvisionclinic.com</p></div><div class="ftHistory-received">Received: January 02, 2013</div><div class="ftHistory-accepted">Accepted: March 18, 2013</div></div><p>10.3928/1081597X-20130719-02</p><p><div class="fb-like" data-href="" data-send="true" data-width="450" data-show-faces="true"></div></p><ul class="share"><li><a id="twitter" href="javascript:void(0)" target="_new"></a></li><li><a id="facebook" href="javascript:void(0)" target="_new"></a></li><li><a id="linkedin" href="javascript:void(0)"></a></li><li><span class="db-wrapper"><span class="g-plusone" data-size="tall" data-annotation="none"></span></span></li><li><a id="email" href="javascript:void(0)"></a></li><li class="last"><a id="print" href="javascript:void(0)"></a></li></ul><div id="respond"><script language="javascript" type="text/javascript"> var idcomments_acct = 'aa6ff53f9870e40f92f83e1b5df3cddf'; var idcomments_post_id = '244c319e-3c4e-423c-a440-568c86f8ebbd'; var idcomments_post_url; </script> <span id="IDCommentsPostTitle" style="display: none"></span> <script type="text/javascript" src="https://web.archive.org/web/20130816061200js_/http://www.intensedebate.com/js/genericCommentWrapperV2.js"></script><p class="comment-notes">Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. 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Improved Effectiveness of Transepithelial PTK Versus Topography-Guided Ablation for Stromal Irregularities Masked by Epithelial Compensation | Journal of Refractive Surgery