Femtosecond laser-assisted small-aperture corneal inlay implantation for corneal compensation of presbyopia: two-year follow-up

J Cataract Refract Surg. 2013 Feb;39(2):234-41. doi: 10.1016/j.jcrs.2012.09.018. Epub 2012 Dec 12.


Purpose: To report the 2-year postoperative safety and efficacy outcomes after monocular Kamra corneal inlay (ACI7000PDT) implantation in femtosecond laser-created corneal pockets of emmetropic presbyopic patients to improve near and intermediate vision.

Setting: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria.

Design: Prospective interventional case series.

Methods: Patients had corneal inlay implantation in the nondominant eye. Emmetropic presbyopic patients between 45 and 60 years old with an uncorrected distance visual acuity (UDVA) of 20/20 or better in both eyes and without additional ocular pathology were eligible. Contrast sensitivity, visual field examinations, endothelial cell count (ECC), and central corneal thickness (CCT) measurements were assessed preoperatively and 12 and 24 months postoperatively. The UDVA, uncorrected intermediate visual acuity (UIVA), and near visual acuity (UNVA) were assessed preoperatively and 1 day, 1 week, and 1, 3, 6, 9, 12, 18, and 24 months postoperatively. The minimum postoperative follow-up was 24 months.

Results: After 24 months, the mean binocular UNVA improved from 20/50 to 20/25; 20 patients (83%) had a UNVA of 20/25 or better. The mean binocular UIVA was 20/20. The mean UDVA was 20/20 in the surgical eye and 20/16 binocularly after 24 months. Contrast sensitivity under photopic and mesopic conditions remained in the range of the normal population. No patient had detectable central visual field defect. No inlay was explanted. No inflammatory reactions were observed. The ECC and CCT remained stable.

Conclusion: The corneal inlay implanted in femtosecond laser-created pockets was effective and safe for the corneal compensation of presbyopia in emmetropic patients after 24 months.

Financial disclosure: Acufocus Inc., Irvine, California, USA, financially supports the Research Foundation for Promoting Ophthalmology, Salzburg, Austria, as the clinical research center of the University Eye Clinic (Paracelsus Medical University). Dr. Grabner received travel expenses from Acufocus, Inc. Dr. Riha currently also works as a clinical application specialist for Acufocus, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

MeSH terms

  • Contrast Sensitivity / physiology
  • Corneal Stroma / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Laser Therapy / methods*
  • Male
  • Middle Aged
  • Nanoparticles
  • Polyvinyls
  • Presbyopia / physiopathology
  • Presbyopia / surgery*
  • Prospective Studies
  • Prostheses and Implants*
  • Prosthesis Implantation*
  • Refraction, Ocular / physiology
  • Surgical Flaps*
  • Treatment Outcome
  • Visual Acuity / physiology
  • Visual Fields / physiology


  • Polyvinyls
  • polyvinylidene fluoride