Mastering Advanced Surface Ablation Techniques Ashok Garg, Frank Jozef Goes, Cyres K Mehta, Christopher J Rapuano
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1Mastering Advanced Surface Ablation Techniques
2Mastering Advanced Surface Ablation Techniques
Editors Ashok Garg MS, PhD, FIAO (Bel), FRSM, ADM, FAIMS, FICA International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk, Hisar-125005 (India) JT Lin PhD Technical Director, New Visionul Inc. Room 826, No. 144, Section 3 Min-Chuan East Road Taipei, Taiwan 105 Christopher J Rapuano MD Co-Director, Cornea Service and Refractive Surgery Deptt., Wills Eye Institute Prof Jefferson Medical College Of Thomas Jefferson University Philadelphia, PA 19170 A John Kanellopoulos MD Director, Laservision gr. Institute Mesogeion 2 Str Athens Tower Building B 11527 Athens, Greece Frederic Hehn MD Chief and Medical Director Centre de La Vision, Nations-Vision 23, Boulevard de l'europe 54500, Vandoeuvre, France Cyres K Mehta MS, FSVH, FAGE Director and Consultant Mehta International Eye Institute Seaside, 147, Colaba Road, Seaside 147, Colaba Road, Mumbai– 400005, India Jorge L Alio MD, PhD Chairman and Professor of OphthalmologyInstituto Oftalmologico De Alicante Avda. Denia 111, 03015 Alicante Spain Frank Jozef Goes FD Medical Director Goes Eye Centre, W Klooslaan 6 B2050 Antwerp Belgium Jerome Jean Bovet MD Consultant Ophthalmic Surgeon FMH Clinique de L'oeil, 15 Avenyue Du Bois-de-law Chapelle CH-1213, Onex Switzerland Roberto Pinelli MD Director, Istituto Laser Microchirurgia Oculare Crystal Palace, Via Cefalonia 70, 25124, Brescia Italy Bojan Pajic MD Chief of the Cornea and Refractive Surgery Department Klinik Pallas Louis Giroud-Str. 20 147, Colaba Road 4600 Olten Switzerland Foreword Emanuel Rosen
3
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Mastering Advanced Surface Ablation Techniques
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2008
9788184482188
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
4Dedicated to
My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and motivation. My respected parents, teachers, my wife Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work.
My dear friend Amar Agarwal, a renowned International Ophthalmologist for his constant support, guidance and expertise.
— Ashok Garg
To Mayca, Jorge, Fernando and Maria Lucia and most especially to my beloved wife Maria, for the hours that were taken from our family life to make this book possible.
— Jorge L Alio
My wife, Jeanette and my sons Alex and Tao, who have been giving me constant support and love.
— JT Lin
My wife, Rita, for the support in my Professional Career and to my four grandchildren—Stephanie, William, Louise and Vincent – with the hope that at least one of them will become an ophthalmologist—as their father and their Daddy did.
— Frank Jozef Goes
My wounderful wife, Sara, a terrific partner at home and at work and to my children, Michael, Patrick, Daniel and Megan, who never stop reminding me what is important in life.
— Christopher J Rapuano
Yveric, Luc and Fanny Laur. Silvio Korol, who was not only a teacher but also an intellectual guide and a friend.
— Jerome Bovet
My parents, the endless and willing teachers and my family: my wonderful wife Nathalie, and our children: Alexander, Angelina and Konstantine.
— A John Kanellopoulos
I dedicate this book to India's Talented ophthalmologists, in the fervent hope that they may become increasingly devoted to refractive surgery.
— Roberto Pinelli
My wife, Marie Laurence and my children Thibaut, David, Carole and Lola.
— Frederic Hehn
To my son Valentin Aleksandar.
— Bojan Pajic
My parents for everything.
To Vini my Best friend.
— Cyres K Mehta
5CONTRIBUTORS 11FOREWORD
As our knowledge advances in the sphere of corneal biomechanics, surface ablation for laser vision correction once again increases its appeal. A resurgence of photorefractive keratectomy, whatever other name may be applied to the technique, limits the structural alteration of the cornea. Topography guided ablation for irregular corneal surfaces or wavefront guided ablation for correction of eye aberrations are indicators of the increasing sophistication of the ablative process.
The text is supported with reviews of the basic science of corneal ablations including biophysics of thermal as well as non-thermal techniques. Experienced surgeons share their pearls which is an invaluable guide for surgeons to avoid pitfalls during their learning curve. Adjunctive methods include reviews of the role of mitomycin C, anti-inflammatory and antibiotic medications to prevent adverse events after treatment. Corneal laser vision correction in common with so many aspects of modern medicine in general and ophthalmology in particular, is a rapidly developing subject and this volume provides immediate insights into the current status of surface corneal ablations.
Surface and near surface ablative techniques form the subject matter of this volume variously characterized as PRK, Epi-LASIK, LASEK and SBK. The collective experience of the world's leading laser vision correction surgeons, have been drawn together by that master of the genre of clinical ophthalmic textbooks Dr Ashok Garg. He always provides up to the minute information for the enlightenment of his readers for he recognized the rapid evolution of knowledge and the need to bring it to notice as soon as possible. Once again he is to be congratulated on another masterly volume which will contribute greatly to the welfare of countless patients who undergo treatment for low and moderate myopia, astigmatism and low hyperopia by the various techniques described herein. Dr Garg's productivity is a modern marvel that deserves all our congratulations and support.
Professor Dr Emanuel Rosen
BSc, MD, FRCSEd, FRCOphth, FRPS
10 St John Street Manchester M3 4DY UK
Tel 44 161 832 8778, Fax 44 161 832 1486
12PREFACE
Since the inception of PRK as Refractive Surgery procedure 20 years back the Laser Refractive Surgery has gone full circle. For the last a few years LASIK has been the attractive and popular refractive procedure worldwide. Recently due to LASIK postoperative long- and short-term severe complications there is renewed interest in Laser Surface Ablation procedure among Refractive Surgeons. Indeed there is resurgence of Advanced Surface Ablation procedures with a bang. Laser vision correction without preparation of a LASIK flap include LASEK, Epi-LASIK, Surface LASIK and SBK which are known as Advanced Surface Ablation Techniques (ASA). As an appeal derives from two unique factors (a) For an equivalent correction (b). It leaves a structurally stronger cornea than LASIK thus lower incidence of corneal ectasia. Advanced Surface Ablation is certainly a better procedure than LASIK for High Myopia, atypical corneal topography, inferior steepning, steep central cornea and high oblique astigmatism. The ASA offers a more conservative option than LASIK.
64 chapters in this International Book practically covers all techniques of Advanced Surface Ablation in comprehensive manner. Leading International Refractive Surgeons have shared their experiences in these chapters and are of opinion that ASA is more safe and stable than that of First Generation Surface Ablation performed with excimer laser.
Hats off to our publisher Sh Jitendar P Vij (CEO), M/s Jaypee Brothers Medical Publishers Pvt Ltd (India), Mr Tarun Duneja (General Manager — Publishing) and all staff members who took keen interest and done hard work in timely preparation of this ASA book first of its kind in the world. With renewed interest in Advanced Laser Surface Ablation procedure worldwide, we are hopeful this unique book shall provide complete information on ASA techniques to every Refractive Surgeon. Next decade certainly belongs to Resurgent Advanced Surface Ablations.
Editors