Professional Documents
Culture Documents
Dr.Jyoti Shetty
Medical Director,
Bangalore West Lions
Superspeciality Eye Hospital
CLASSIFICATION
REFRACTIVE SURGERIES
-R.K.
-Clear Lens Combination
-PRK
extraction for of the two
-LASIK
myopia
-EPILASIK
-Phakic IOL
-LASEK
- Prelex Clear
-Conductive
Lens Extraction
Keratoplasty
with use of
-Corneal
Multifocal IOL’s
Inlays and
rings
LASIK(Laser Assisted In Situ
Keratomileusis)
Procedure using laser to ablate the
tissue from the corneal stroma to
change the refractive power of the
cornea
Types of lasers used-
Excimer-Excited dimer of two atoms
-an inert gas(Argon)
-Halide(Fluoride)
which releases ultraviolet energy at193nm
for corneal ablation
Non-Excimer solid state lasers-
210nm Q switched diode pumped laser (laser
off)
213 nm Q switched diode pumped
laser(Pulsar)
Advantage of Non-Excimer solid state
lasers-
No toxic excimer gases
Wavelength closer to absorption peak of corneal
collagen—less thermal and collateral damage
Better pulse to pulse stability
Not absorbed by air,water,tear fluid-so less
sensitive to humidity or room temperature
No purging with inert gases required.
Patient selection
Beam Delivery
MICROSTRIAE
Bleeding during flap cutting due to
corneal neovascularization in contact
lens users
Interface Inflammation(Sands Of
sahara/DLK)-Non-Infective
inflammation at the interface seen in 1st
week after LASIK.
Diffuse,confluent,white granular material
at the interface 1-7 days after LASIK.
Slight CCC
No AC reaction
Reduced Visual acuity
Grade 1-
Focal involvement -
Normal V/A.
Rx Intensive
topical steroids.
II – Diffuse
involvement –
Normal V/A.
Rx-Add
systemic steroids.
III – Diffuse confluent
granular deposits-
Reduced V/A.No AC
reaction.
Rx-Same as
above+Antibiotics
IV - Diffuse confluent
granular deposits
+intense central striae.
Marked Reduced
V/A
Rx-Interface
irrigation + above
Causes-Proposed Theory
Bacterial cell wall endotoxin
Cleaning solution toxicity
Talc from gloves
Miebomian secretions
Infection-Potential complication as any
surgical procedure
Epithelial ingrowth-Presents 1-3
months after LASIK.
Causes-Epithelial cells trapped under flap
Risk factors-Peripheral epithelial defects
-Poor flap adhesion
-Buttonholed flaps
-Repeat LASIK
Classification-
GRADE 1-Faint white line <2mm from flap
edge
GRADE 2-Opaque cells <2mm from flap
edge with rolled flap edge
GRADE 3-Grey to white fine opaque line
extending >2mm from flap edge.
GRADE 4-If ingrowth >2mm from edge with
documented progression—Lift flap and
remove the sheets of epithelium.Can use
MMC.
EPILASIK / LASEK
Anterior stroma of cornea (ant. 1/3 rd)
has stronger interlamellar connections
than post. 2/3rd.
So surface ablation preserves the
structural integrity better than LASIK
especially in the correction of
moderate to high myopia.
LASEK-Camellins Technique-
20% absolute alcohol used for 20-35s. To
raise epithelial flap.
Flap reposited after ablation
EPILASIK- Epithelial keratome used to
lift epithelial flap of about 60-80µ thick.
Epithelial keratomes use
- PMMA blades
-Metal Epithelial Separator
CONDUCTIVE
KERATOPLASTY
Uses mild heat from radiofreqoency waves
to shrink collagen in the periphery of the
cornea---This steepens the paracentral
cornea.
Used for hyperopia (1 – 2.25D) and
presbyopia.
C.K. spots are applied with a probe in rings
with a dia. Of 6/7/8 mm.
8 spots are given in each diameter ring.
6 7
5mm
Drawbacks-
Regression and retreatment in 100%
cases after 6 months.
Induced cylinder >1D reported in many
cases.
Usually done in one eye—Many have
intolerance to monovision.
CORNEAL INLAYS
Increase the depth of focus by using pinhole
optics.
Inlays have 1.6mm centre with 3.6mm
surround.
Near vision improves by 1.5D with no loss of
distant vision.
Used in the non –dominant eye.
These are hydrogel based.Placed in a
tunnel 200-400 µ deep in centre of cornea.
AcuSof Corneal inlay
Phakic IOLs
An intra-ocular lens is placed inside the eye
in front of the patient’s natural lens.
These are available in three types
1. Anterior chamber angle fixated IOL – Nuvita
(Bausch & Lomb), Kelman duet, I care (corneal),
Vivarte (Ciba vision)
2. Iris supported phakic IOL – Verisyse/ Artisan
(AMO/Ophtec)
3. Plate lens that fits between the iris & the
crystalline lens – Starr implantable contact lens
(ICL), PRL (Ciba).
Indications