CONDUCTIVE KERATOPLASTY

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CONDUCTIVE KERATOPLASTY

• DR. HIMANSHU MEHTA
• LILAVATI HOSPITAL
• NANAVATI HOSPITAL
• VISSION EYE CENTRE

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• Are you 45 years or older?
• Do you have good distance vision?
• Do you dislike wearing
  reading glasses?
• If so, ask us how you may benefit from
  NearVision CK!

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You need CK
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• CKSM A thermokeratoplasty technique that uses RF
  energy to heat and reshape the cornea

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Conductive KeratoplastySM Mechanism

• Radiofrequency energy (350 KHz)
• Delivered into the stroma with a 450 x 90 µm
  contact probe (for 0.6 sec)
• Temperature and duration is optimal for collagen
  shrinkage without denaturation of protein

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Conductive KeratoplastySM Footprint

• Histology of pig cornea (650 µm) 1 week after CK
• Cylindrical footprint
• 250 µm wide
• 509 µm deep

light transmission polarization
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One Hour CK Post-Op
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Summary of Biomechanical Effects

• Apical corneal elevation with slight steepening
• Central cornea steepening
• 6.5mm to 7.0mm O.Z.
• Treatment belt zone is flattened as result of
  decreased circumference
• 1.5mm to 3.5mm in width
• Passive peripheral corneal flattening with limbal
  tethering

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Orbscan Corneal Topography
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Multifocal Cornea

• Prolate corneal shape maintained
• Increased asphericity
• Reduced hyperopia
• Lines of reading improvement out of proportion to
  induced myopia

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Current Applications of Conductive KeratoplastySM

• Modified Approved Indications
• Spherical Hyperopia 0.75 D to 2.50 D
• Plano Presbyope -0.75 to 1.00
• Patients 45 years of age or older
• Potential off Label
• Astigmatism
• Enhancing LASIK corrections
• Refining cataract outcomes

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Functional Target Blended VisionSM

• Both eyes blended together to optimize
  functional vision
• Temporary Monovision
• Common Target -1.00 to -1.75 D in non-dominant
  eye no matter what age
• Most well selected patients will initially only
  need one eye done
• We have found very high rate of patient
  satisfaction

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CKs Unique Patient AppealConsumer Research of
Individuals 40 - 60

• What are the factors for considering refractive
  surgery?
• Safety 87
• No cutting 67
• In-office 51

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CK Work Up

• Complete exam including cycloplegic refraction
• Determine eye dominance
• Pachymetry at 6 mm OZ 4 quadrants
• Careful lens examination for cataracts
• Loose Lens exam
• Contact lens trial in selected patients

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Peripheral Asymmetry
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CKSM Surgery
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Surgical GoalRound, More Prolate Cornea
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Deceptively Simple Procedure

• Instill topical anesthesia
• Insert CK lid speculum
• Mark eye
• Apply treatment
• Confirm satisfactory sphericity
• Total time less than 4 minutes

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System Components
Keratoplast Tip (450 x 90 µm)
ViewPoint CK System
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CKSM Markers
Strauss Corneal Marker
Standard CK Marker
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Nomogram and Sequence
Sequence
8 spots (1.00 D)
8 spots 1.75
1
5
8
3
4
6
7
2
6 mm OZ
7 mm OZ
16 spots ( 2.25 D)
24 spots (3.5D)
8 mm OZ
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Center Eye in Field

• Avoids parallax
• Surgeon can keep both eyes open for marking

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Normal Centration
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CKSM Marking Technique
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CKSM Point Marker
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Spot Placement Technique

• Primary surgery 3/6/9/12 pattern
• Perpendicularity
• Exact radial alignment
• Kissing spots (build a snowman)

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Post-Op Management toReduce Discomfort

• Ice cold compresses prn
• Artificial tears
• Hypotears or Refresh - no gels
• Treat eyelid conditions

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