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Refractive Surgery
Ashok Garg, Emanuel Rosen, Frank Jozef Goes, Jerome Jean Bovet
SECTION 1: CORNEAL REFRACTIVE SURGERY
1:
Refractive Errors of the Eye
INTRODUCTION
MYOPIA
Optical Principles
Clinical Signs and Symptoms
INVESTIGATIONS
Differential Diagnosis
Treatment
Prognosis
HYPERMETROPIA
Optical Principles
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
Prognosis
ASTIGMATISM
Optical Principles
Clinical Signs and Symptoms
Investigations
Treatment
Prognosis
PRESBYOPIA
Optical Principles
Clinical Signs and Symptoms
Investigations
Differential Diagnosis
Treatment
2:
Basic Optics of Refractive Surgery
LIGHT, PHYSICAL OPTICS, GEOMETRICAL OPTICS
REFLECTION, REFRACTION, DIFFRACTION, SCATTERING OF LIGHT
ABERRATION, WAVEFRONT ABERRATION, CHROMATIC ABERRATION
EMMETROPIA, MYOPIA, HYPEROPIA, PRESBYOPIA
CURVATURE, RADIUS OF CURVATURE
Q-FACTOR, PROLATE, OBLATE
OPTICAL AXIS, VISUAL AXIS
MTF, PSF
3:
Pathophysiology of Various Refractive Errors Like Myopia, Hyperopia, Astigmatism, Accommodation and Presbyopia
ACCOMMODATION AND PRESBYOPIA
Theories of Accommodation
Failure of Accommodation; Presbyopia
4:
Orbscan
INTRODUCTION
PARAXIAL OPTICS
RAYTRACE OR GEOMETRIC OPTICS
ELEVATION
ORBSCAN I AND II
SPECULAR VS BACK-SCATTERED REFLECTION
IMAGING IN THE ORBSCAN
MAP COLORS CONVENTIONS
ANALYSIS OF THE NORMAL EYE BY THE ORBSCAN MAP
CLINICAL APPLICATIONS
SUMMARY
5:
Photorefractive Keratectomy with Mitomycin C for High Myopia
INTRODUCTION
INVESTIGATIONS
6:
Photorefractive Keratectomy after Penetrating Keratoplasty
INTRODUCTION
INVESTIGATIONS
PREOPERATIVE CONSIDERATIONS
CONCLUSION
7:
Phototherapeutic Keratectomy on Recurrent Corneal Erosions
INTRODUCTION
Clinical Signs and Symptoms
Differential Diagnosis
Treatment
Investigations
Prognosis
8:
Myopic Photorefractive Keratectomy Using Solid State Laser
INTRODUCTION
LASERS PRINCIPLES OF FUNCTION
ACHIEVING THE FIFTH HARMONIC
CUSTOMVIS PULZAR Z1 SOLID STATE LASER
Clinical Results
EXPERIMENTAL CORNEAL HISTOLOGY
CONFOCAL MICROSCOPY ANALYSIS
CONCLUSION
9:
Photorefractive Keratectomy for Residual Myopia following Radial Keratotomy
INTRODUCTION
PREOPERATIVE CONSIDERATIONS
Investigations
CONCLUSION
10:
Recent Advances in Photorefractive Keratectomy
INTRODUCTION
PRK WITH MMC
Haze after PRK
Mitomycin C use as Prophylaxis and Treatment for Haze
Surgical Technique of PRK with MMC
Mitomycin C Side Effects
ASCORBATE PROPHYLAXIS AFTER PRK
WAVEFRONT-GUIDED PRK
Comparison between Standard PRK and Wavefront-guided PRK
Comparison of Wavefront-guided PRK with Wavefront-guided LASIK
TOPOGRAPHY-GUIDED PRK
Q FACTOR CUSTOMIZED PRK
Table 2 Summarizes the Various Types of Conic Sections with the Corresponding Values of the Different Shape Factors
PRK IN THE TREATMENT OF PRESBYOPIA
PRK WITH SOLID STATE LASERS
11:
Painless EpiLASIK
SURGERY PROCEDURE
Epi-trephine Assisted LASEK Technique
Epi-LASIK Technique
Advantages of Rotational Epikeratome
POSTOPERATIVE MANAGEMENT
Bandage Contact Lens
EYEDROPS
12:
Wavefront-guided Photorefractive Keratectomy—Today and the Future
INTRODUCTION
WHAT IS WAVEFRONT TECHNOLOGY?
CUSTOM WAVEFRONT PRK
CLINICAL RESULTS
LIMITATIONS
SUMMARY
13:
Presby-EpiLASIK in Pseudophakic Eyes with the Wavelight Allegretto
INTRODUCTION
Relationship between Q Value Asphericity and Amount of Spherical Aberrations
Why EpiLASIK is Necessary in Some Cases
Interest of using a Spherical Aberration Free IOL to Correct Presbyopia in Pseudophakic Eye
What Happens with Q Value and SA During Accommodation
Clinical Examples
T-CAT IS THE CLUE
CONCLUSION
14:
EpiLASIK with Mitomycin C
HISTOLOGICAL FINDINGS
PRINCIPLE OF EPILASIK
Procedure
INTRAOPERATIVE COURSE
POSTOPERATIVE TREATMENT
Clinical Deductions
CONCLUSION
15:
One-shot Epithelium-rhexis: Personal Technique
INTRODUCTION
Questions
Description
CONCLUSION
16:
Surface Ablation after Laser In Situ Keratomileusis; Retreatment on the Flap
TECHNIQUE
17:
Wavefront Analysis and its Clinical Significance
THE CONCEPT OF THE WAVEFRONT ABERRATION
METHODS OF DESCRIBING WAVEFRONT ABERRATION
THE SIGNIFICANCE OF ZERNIKE ABERRATIONS
INTERACTION AMONG WAVE ABERRATIONS
Clinical Examples
18:
Wavefront LASIK
INTRODUCTION
ADVANTAGES OF WAVEFRONT GUIDED LASIK
LIMITATIONS OF WAVEFRONT GUIDED LASIK
LASER FACTORS
BIOMECHANICAL ISSUES
ROLE OF THE PUPIL
THE OPTICAL ZONE
CORNEAL WOUND HEALING
DECENTRATION
TEAR FILM
CONCLUSION
19:
Aspheric Ablation with Nidek Platform
THE NIDEK ADVANCED VISION EXCIMER LASER SYSTEM (NAVEX)
The OPD Scan
The OPD Software
The Final Fit
The NAVEX
The Ablation Profiles
20:
Customized Excimer Laser Treatment Using the Wavelight Allegretto Eye Q Laser
WHAT IS CUSTOMIZED EXCIMER LASER TREATMENT?
THE LASER
TREATMENT PRINCIPLES
Corneal Asphericity
REQUIREMENTS FOR CUSTOM ABLATION
THE DIFFERENCE BETWEEN WAVEFRONT GUIDED AND TOPOGRAPHY GUIDED CUSTOM ABLATION
INDICATIONS FOR CUSTOM ABLATION
General Indications
Indications for the Standard or Wavefront Optimized [WFO] Treatment
Indications for Custom Q Treatment [F-CAT]
T-CAT Following Previous PKP
T-CAT after Previous RK
Indications for Oculink Ablation Based on the Oculyzer
Indications for A-CAT
OBTAINING MAPS FOR CUSTOM ABLATION TREATMENT
Measuring Technique
DIFFERENT MAPS
Topolyzer Maps
Oculyzer Map
TREATMENT PROGRAMS
Standard Treatment Program
Custom Q Program [F-CAT]
T-Cat Treatment
T-CAT after Previous Penetrating Keratoplasty [PKP]
T-CAT After Previous RK
T-CAT for Other Indications
Oculink Treatment Program
A-CAT [Wavefront Analyzer Guided Custom Ablation Treatment]
RESULTS
Results of Wavefront Optimized [or Standard] Treatment
Results of Custom Q treatment [F-CAT]
Results of Wavefront Guided Treatment [A-CAT]
T-CAT Results
COMPLICATIONS OF CUSTOMIZED ABLATION
General Complications
Complications of Standard [WFO] Ablation
Complications of Custom Q Ablation
Complications of A-CAT
Complications of T-CAT
LASIK vs ADVANCED SURFACE ABLATION combined with customized ablation
Lasik with Custom Ablation
Advanced Surface Ablation [ASA] with Custom Ablation
21:
Advances in EpiLASIK and LASEK
METHODS
Patients
Examination
Surgery Procedures
Surgery Procedure LASEK
EpiLASIK Surgery Procedure
Comparison of the Different Techniques
Data Analysis
RESULTS
Efficiency
Predictability
Safety
DISCUSSION
Acknowledgments
22:
Wavef ront Optimize and Astigmatism Correction with the Allegretto Excimer Laser
NORMAL CORNEAL SHAPE AND ASPHERICITY
SPHERICAL ABERRATION
WAVEFRONT OPTIMIZED TECHNOLOGY
CLINICAL IMPLICATIONS
ASTIGMATISM
TYPES OF ASTIGMATISM
Based on Axis of the Principal Meridians
Based on Focus of the Principal Meridians
Photorefractive Excimer Laser Astigmatic Correction
Wave front-guided Laser Vision Correction
CONCLUSION
23:
Aberropia: A New Refractive Entity
INTRODUCTION
Materials and Methods
Discussion
CONCLUSION
24:
Topographic and Aberrometer Guided Laser
INTRODUCTION
ABERRATIONS
ZYOPTIX LASER
ORBSCAN
ABERROMETER
ZYLINK
RESULTS
DISCUSSION
CONCLUSION
25:
Refractive Change after RK
SIGNS AND SYMPTOMS
FURTHER INVESTIGATIONS
Differential Diagnosis Discussion
TREATMENT
Prognosis
26:
LASIK Complications and Management
MICROKERATOME-RELATED AND FLAP-RELATED
Irregular Cap/Flap
DISLODGED FLAP
FAINT STRIAE (MICROSTRIAE
MACROSTRIAE
EXCIMER LASER-RELATED
Decentered ablation
UNDERCORRECTION, REGRESSION
CENTRAL ISLAND
HEALING/INFECTION/INFLAMMATION
Epithelial Ingrowth
Prevention:
Management:
DIFFUSE LAMELLAR KERATITIS (DLK)
INFECTIONS KERATITIS
INTERFACE DEBRIS AND REMNANTS
OTHERS
Dry Eye/Neurotrophic Epitheliopathy
Risk factors:
Prevention:
Management:
ECTASIA
ACKNOWLEDGEMENT
27:
Cross-linking Plus Topography-guided PRK for Post-LASIK Ectasia Management
OPTIONS FOR TREATMENT
IMPROVEMENT IN VISUAL ACUITY
TREATMENT OF IATROGENIC KERATECTASIA
A Similar Example Follows
MINIMAL CORNEAL THICKNESS
28:
PRK for Low to Moderate Myopia
INTRODUCTION
CONCLUSION
29:
LASEK Procedure with the Use of Mitomycin C
SUMMARY
30:
Transepithelial Cross-linking for the Treatment of Keratoconus
INTRODUCTION
CORNEAL COLLAGEN NETWORKS
PHOTOCHEMICAL CROSS-LINKING
RIBOFLAVIN-UVA TREATMENT
CORNEAL EPITHELIUM
31:
Sub Bowman‘s Keratomileusis: Combining the Best of PRK and LASIK for Optimal Outcomes
SURGICAL TECHNIQUES FOR SBK AND PRK
MEASUREMENT OF RESULTS
STUDY RESULTS
Flap Thickness Results
Visual Results
Retinal Image Quality
Contrast Visual Acuity
Wavefront Aberrometry
Biomechanical Results
ORA RESULTS
PASCAL TONOMETER
Dry Eye and Corneal Sensitivity Results
Dry Eye
CORNEAL SENSITIVITY RESULTS
Subjective Results
SIGNIFICANCE OF RESULTS
32:
cTEN™ (custom Transepithelial “No-touch, One-step, All-laser”) Refractive and Therapeutic Ablations with the iVIS™ Suite
DIAGNOSTIC PRODUCTS
PRECISIO™: HIGH DEFINITION CORNEAL AND ANTERIOR CHAMBER TOMOGRAPHY
pMetrics™: Dynamic Pupil Assessment and Ideal Pupil Determination
The Ideal Pupil
SURGICAL DESIGN PRODUCTS
CIPTA™ - Corneal Interactive Programmed Topographic Ablation
Morphologic Axis vs. Optic Axis
Variable Width Constant Slope Transition Zone
CLAT™ - CORNEAL LAMELLAR ABLATION FOR TRANSPLANTATION
The Host
The Donor
IRES™ - HIGH RESOLUTION, ULTRA-FAST CUSTOM REFRACTIVE AND CUSTOM THERAPEUTIC LASER
CONSTANT FREQUENCY PER AREA™
33:
Astigmatism
SIGNS AND SYMPTOMS
FURTHER INVESTIGATIONS
Differential Diagnosis Discussion
Discussion
Treatment
Prognosis
34:
Customized LASIK for Presbyopia: PML™(Presbyopic Multifocal LASIK) Technique
THE CORRECTION OF PRESBYOPIA
APPROACHES TO THE SURGICAL CORRECTION OF PRESBYOPIA
THE PML™ PROCEDURE
CLINICAL CASES: EXAMPLES OF CUSTOMIZED PRESBYOPIC TREATMENT WITH PML™
Case Example I: Emmetropic-presbyope
Clinical History
Case Example II: Hyperopic-presbyope
Case Example III: Myopic-presbyope
Case Example IV: Mixed Astigmatic-presbyope
Final Considerations
35:
Amblyopia
SIGNS AND SYMPTOMS
FURTHER INVESTIGATIONS
Differential Diagnosis- Discussion
Treatment
Prognosis
36:
Laser Scleral Ablation for True Accommodation for Presbyopia
INTRODUCTION
THE AGEING EFFECTS OF HUMAN EYES
PRESBYOPIA TREATMENT TECHNIQUES
THE MECHANISMS
THE LIN-KADAMBI HYPOTHESIS
THE 4-COMPONENT THEORY
CLINICAL RESULTS
CONCLUSION
37:
Solid State Lasers for Refractive Surgery
INTRODUCTION
BASIC LASER BACKGROUND
Light Amplification by Stimulated Emission of Radiation
LASER PUMPS
LASER MEDIA
COMMON PROPERTIES OF LASERS
EXCIMER LASER
Basic Concepts
DISADVANTAGES OF EXCIMER LASER
High Voltage Requirement
Early Replacement of Special Switch
Corrosiveness and Toxicity of Fluorine Gas
Recurrent Expenses of Excimer Gases
High Cost for Proper Storage of Toxic Gases and Training of a Technician
Hydration Dependence of 193 nm
Other Disadvantages of Excimer Laser
SOLID STATE LASERS IN REFRACTIVE SURGERY
SOLID STATE LASER
History
Present Situation
Future of Solid State Laser
TECHNICAL ADVANTAGES OF SOLID STATE LASER
Solid State Technology
Advantages of Solid State Laser
213 nm Wavelength
Tissue Hydration Study
Clinical Advantage
HISTOPATHOLOGICAL COMPARISON OF PHOTOREFRACTIVE KERATECTOMY (PRK) IN RABBITS WITH 193 NM AND 213 NM
Introduction
Methods
Analysis
Discussion
SCIENTIFIC BENEFITS
SPECIAL FEATURES AVAILABLE TO THE PULZAR Z1
Eye Tracking
Gaze tracking
ZTRAK
Gaze Tracking
Unique Advantages of Limbus Eye Tracking (PULZAR Z1 Tracking System)
Cyclorotation
0.6 mm Flying Gaussian Beam Spot
CRYSTALSCAN
HINGE PROTECTION
Advantages of Hinge Protection
AUTO-CENTRATION
AUTO-CALIBRATION
Advantages of Auto-calibration
FREEDOM TO SELECT TREATMENT CENTER
CORNEAL HYDRATION DURING ABLATION
NOMOGRAM ADJUSTMENT
ANYTIME SURGERY - FREEDOM TO DO SURGERIES AT YOUR CONVENIENCE
LESS MAINTAINANCE AND COST
SAFETY FEATURES
Foot Switch
Laser Enable Button
Emergency Stop Button
TREATMENT PLANNING
STANDARD TREATMENTS
STANDARD TREATMENT FEATURES IN PULZAR Z1
Maintenance of Preoperative Corneal Asphericity
Saving Entered Treatments
Resuming an Aborted Ablation Process
CUSTOMISED TREATMENTS
Special Features of ZCAD 388
Freedom of Choice of Optical Zone and Treatment Zone
Refraction Adjustments - Surgeon's Choice
Automatic Cylinder Notation Conversion
Corneal Asphericity Customization
Depth Offset
CT Scale
TRACEY WAVEFRONT ANALYSER
Data Displays
Other Advantages of Tracey
Tracy and CustomVis Pulzar Z1
CLINICAL OUTCOMES
Latest Clinical Results
Myopia - Moderate to High (Up to -14.5 D Sphere and up to -5.5 D of Astigmatism)
Attempted Vs Achieved graph
THE BOTTOM LINE
38:
Dry Eye after Refractive Surgery
INTRODUCTION
INVESTIGATIONS
CLINICAL SIGNS AND SYMPTOMS
CHRONIC DRY EYE AFTER LASIK
RISK FACTORS FOR DRY EYE AFTER REFRACTIVE SURGERY
TREATMENT
39:
Corneal Biomechanical Properties
INTRODUCTION
TERMINOLOGY
Corneal Hysteresis
Corneal Resistance Factor
OCULAR RESPONSE ANALYZER (ORA)
CORNEAL BIOMECHANICAL PROPERTIES IN NORMAL, KERATOCONIC EYES AND POSTLASIK EYES
40:
Future of LASIK Surgery
INTRODUCTION
ADVANCED TECHNOLOGIES
SURFACE TREATMENT VS LASIK
Lenticular Refractive Surgery
SECTION 2: LENTICULAR REFRACTIVE SURGERY
41:
Refractive Management of Hyperopia
INTRODUCTION
CLINICAL SIGNS AND SYMPTOMS
INVESTIGATIONS
MANAGEMENT
PROGNOSIS
42:
Restoration of Accommodation by Capsular Bag Refilling
INTRODUCTION
REFILLING THE LENS CAPSULE WITH CAPSULOTOMY-CAPTURING INTRAOCULAR LENS
IOL
Surgical Procedure
RESULTS AND DISCUSSION
Expected Mechanism of Accommodation
Enhancement of Accommodation-Amplitude and PCO-Prevention by Dual-Optic
SUMMARY
43:
Custom ICLs
INTRODUCTION
THE CONCEPT OF CUSTOM PHAKIC IOL
Custom sizing the Overall Length
CONCLUSIONS
44:
Mini Incision IOL Implantation— Current Scenario
MINI-INCISION IOLS
Mini Incision IOL Design
Thickness
Optic Diameter
Optic Properties
IOLs that can Fit Mini Incision
Mini Incision Cartridges
45:
Monofocal HOA Free IOL to Correct Secondary Presby-LASIK
INTRODUCTION
PRESBY-LASIK IN MONOFOCAL PSEUDOPHAKIC EYE
INTEREST OF USING AN IOL HOA FREE TO CORRECT PRESBYOPIA IN PSEUDOPHAKIC EYE
RELATIONSHIP BETWEEN Q VALUE ASPHERICITY AND AMOUNT OF SPHERICAL ABERRATIONS
WHAT HAPPENS WITH Q VALUE AND SA DURING ACCOMMODATION
PRESBY-LASIK HAS TO MINE CRYSTALLINE ACCOMMODATION, WITH Q VALUE < 0 TO INCREASE THE DEPTH OF FOCUS
Distant vision in Central Cornea
Near Vision in Central Cornea
Direct Q Value Adjustment with F-CAT
STRATEGY: ONLY TOPOLINK IS RECOMMENDED IN PSEUDOPHAKIC: T-CAT IS THE CLUE
CLINICAL EXAMPLES
Distant Vision in Central Cornea
Near Vision in Central Cornea
CONCLUSION
46:
Managing Intraoperative Floppy Iris Syndrome
47:
Artisan, Toric Artisan and Artiflex Phakic Intraocular Lenses
GENERAL DISCUSSION
Different Types of Phakic IOL's [PIOL's]
History
Qualities of the Artisan Spheric PIOL
Surgery for the Artisan PIOL
Anesthesia
Complications
Results of the Spheric Artisan PIOL
Qualities of the Artisan Toric PIOL
I Indications for the Artisan Toric PIOL
I Contraindications for Toric Artisan [same as for Artisan PIOL]
Surgery for Toric Artisan PIOL
Calculating the Power of the Toric PIOL
Complications of Position of the Toric Artisan PIOL
Postoperative Complications
Results of the Toric Artisan PIOL
ARTIFLEX FOLDABLE IRIS CLIP PIOL
Indications for Use of the Artiflex PIOL
Contra-indications
Surgery
Anesthesia
Incision
Results
Complications
INTRAOPERATIVE COMPLICATIONS
Demanding Surgery
Wound Complications
OVD Complications
Complications of Position of the PIOL
Postoperative Complications
Late Complications
EFFECTS OF ARTISAN AND ARTIFLEX PHAKIC IOL'S ON THE EYE
Effects on the Endothelium
Effects on the Iris
Effects on the Crystalline Lens
Effects on the Intraocular Pressure
Effects on the Anterior Chamber Angle
SUMMARY
48:
Orthokeratology
HOW IT WORKS?
OVERNIGHT ORTHOKERATOLOGY
REVERSE GEOMETRY CONTACT LENS DESIGN
THE IDEAL FITTING
SELECTION OF PATIENTS
LIMITS
RISK ANALYSIS
SOME CASES
Efficacy and Safety of Overnight Orthokeratology by Means of a Customized Hexa-curve Reverse Geometry Lens
CORNEAL THICKNESS
49:
Aspheric IOLs (Wavefront Based IOLs)
UNDERSTANDING SPHERICAL ABERRATION
SPHERICAL ABERRATIONS IN A HUMAN EYE
In a Young Eye
I In the Elderly Eye
CONVENTIONAL SPHERICAL IOLs
THE TECNIS LENS (AMO)
Fitting Philosophy
THE ACRYSOF IQ (IMAGE QUALITY) (ALCON)
Fitting Philosophy
AKREOS ADAPT AO (ADVANCED OPTIC) (BAUSCH AND LOMB)
Fitting Philosophy
Comparison of Aspheric IOLs
50:
Dual Optic Accommodative IOLs
51:
Anterior Chamber Phakic IOL with Angle Fixation
ADVANTAGES
HISTORY
TYPES OF PHAKIK LENS
Morcher GMBH 93 A
Baikoff Model ZB5MF
Phakic 6 Model 130
Nuvita Baikoff MA 20
Kelmnan Duet
INCLUSION CRITERIA
SURGICAL TECHNIQUE
COMPLICATIONS
Conclusion
52:
Advances in Microphakonit for Refractive Lens Exchange (MIRLEX)— A New Technique
SUMMARY
HISTORY
SURGICAL TECHNIQUE
Instrumentation
Patient Preparation
Surgical Steps
Avoiding Complications
Postoperative Care
Final Comments
53:
Blue Light Filtering Intraocular Lenses
UV-RELATED EYE DISEASES
PROTECTIVE MECHANISMS IN THE HUMAN EYE
MECHANISM OF ACTION OF FILTERING IOLS
TYPES OF FILTERING IOLS
CLINICAL USE
LIMITATIONS
CONCLUSION
54:
Refractive Lens Exchange: Current Perspectives*
55:
Advances in Optic Designs to Reduce PCO
INTRODUCTION
OPTIC EDGE DESIGN
IOL OPTIC MATERIAL
IOL HAPTIC DESIGN
Haptic Angulation
1-piece/3-piece IOLs
SUMMARY
INDEX
TOC
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