title: Short-term visual result after simultaneous photorefractive keratectomy and small-aperture cornea inlay implantation.
abstract: OBJECTIVE
  To report the short-term results of simultaneous photorefractive keratectomy (PRK) and small-aperture cornea inlay implantation (KAMRA) surgery in treating presbyopia.
  
  
  METHODS
  Simultaneous PRK and KAMRA inlay surgery was performed on 21 patients from July 2015 to March 2016. Follow-up exams were conducted at 1, 3, and 6 months postoperatively. Our patients were also divided preoperatively into three categories: myopic, hyperopic, and emmetropic. Over the 6-month period, the main outcome measures were uncorrected near visual acuity (UNVA), changes in best-corrected distance visual acuity, and mean spherical equivalent refraction.
  
  
  RESULTS
  At 6-month follow-up, 83% (10/12) of patients had a monocular UNVA of 20/40 or better, and 75% had a binocular UNVA of 20/40 (J5) or better. At 6 months, the overall mean refractive spherical equivalent (MRSE) was -0.60 D (±0.42 standard deviation [SD], range: -1.38 to -0.13) with a mean change of -0.43 D (±1.19 SD, range: -1.5 to 2.63) compared to preoperative data. Overall, 91% (10/11) of patients were within a ±0.5 D range of our target -0.75 D for KAMRA use. One-hundred percent (5/5) of the hyperopes, 50% (1/2) of emmetropes, and 100% (4/4) of myopes met the targeted range. At 6 months, the MRSE for the hyperopic subgroup (n=5) was 0.33 D (±0.20 SD), the MRSE for the emmetropic subgroup (n=2) was -1.19 D (±0.19 SD), and the MRSE for the myopic subgroup (n=4) was -0.66 D (±0.36 SD).
  
  
  CONCLUSIONS
  Based on preliminary results and a small sample size, it seems that simultaneous PRK and KAMRA is effective and predictable. There are multiple advantages in performing simultaneous PRK and KAMRA including a shorter recovery time and less steroid use than the two surgeries performed separately.
authors.affiliation: Hoopes, Durrie, Rivera, Research Center, Hoopes Vision, Draper, UT; Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Majid
authors.initials: M
authors.lastname: Moshirfar
authors.affiliation: Brigham Young University, Provo, UT.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Wallace
authors.affiliation: McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: David F
authors.initials: DF
authors.lastname: Skanchy
authors.affiliation: Tufts University School of Medicine, Boston, MA.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Desautels
authors.affiliation: Hoopes, Durrie, Rivera, Research Center, Hoopes Vision, Draper, UT.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Linn
authors.affiliation: Hoopes, Durrie, Rivera, Research Center, Hoopes Vision, Draper, UT.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Hoopes
authors.affiliation: Hoopes, Durrie, Rivera, Research Center, Hoopes Vision, Draper, UT; Durrie Vision, Overland Park, KS, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Durrie
keywords: KAMRA; PRK; PRKamra; corneal; femptosecond; presbyopia