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Surgical Techniques in Ophthalmology (Refractive Surgery)
Ashok Garg, Jorge L Alio
SECTION I: CORNEAL REFRACTIVE SURGERY
CHAPTER 1:
Regenerative Aspects of Excimer Laser Ablation
TECHNOLOGY OF KERATOREFRACTIVE SURGERIES
TECHNOLOGY OF LASIK PROCEDURE
TECHNOLOGY OF PRK OPERATION
Results and Discussion
CHAPTER 2:
Pentacam Analysis in Refractive Surgery
NORMAL EYE
SCREENING BEFORE REFRACTIVE SURGERY
CORNEA ECTASIA AFTER REFRACTIVE SURGERY
Other Specific Evaluation
Holladay Report
Holladay Equivalent K-Readings (EKR) Detail Report
Belin Enhanced Ectasia Display
IOP Correction
Astigmatism
Thin Cornea
Early Keratoconus
Keratoconus
Posterior Ectasia
CHAPTER 3:
Orbscan Corneal Mapping in Refractive Surgery
INTRODUCTION
ORBSCAN CORNEAL MAPPING FOR REFRACTIVE SURGERY DIAGNOSTICS
SELECTION CRITERIA
POWER MAPS
POSTERIOR ELEVATION
PACHYMETRY
COMPOSITE/INTEGRATED INFORMATION
CHAPTER 4:
Online Optical Coherence Pachymetry (OCP)
INTRODUCTION
ONLINE OCP INCREASES SAFETY DURING LASIK
Various Ways of Measuring Corneal Thickness
DISCUSSION
OCP VERSUS ULTRASOUND PACHYMETRY
Advantages of OCP
CONCLUSION
CHAPTER 5:
Photorefractive Keratectomy
INTRODUCTION
PREOPERATIVE EVALUATION
SURGICAL TECHNIQUE FOR PRK
SURGICAL TECHNIQUE OF PRK WITH MMC
PRK Postoperative Care
PRK Complications
Intraoperative Complications
Postoperative Complications
CHAPTER 6:
Myopic Photorefractive Keratectomy using Solid State Laser
INTRODUCTION
LASER PRINCIPLES OF FUNCTION
Achieving the Fifth Harmonic
Custom Vis Pulzar Z1 Solid State Laser
CLINICAL RESULTS
EXPERIMENTAL CORNEAL HISTOLOGY
CONFOCAL MICROSCOPY ANALYSIS
CONCLUSION
CHAPTER 7:
The Role of Phototherapeutic Keratectomy Today
INTRODUCTION
Example of Regenerative Wound Healing after Severe Injury to the Cornea
Diagnoses
Iatrogenically Produced Refractive Errors
KERATOCONUS
CORNEAL DYSTROPHIES
Corneal Scars, Band Keratopathy, Pterygium and High Myopia
CONCLUSION
BIBLIOGRAPHY
PTK A
PTK B
CHAPTER 8:
Simultaneous Collagen Crosslinking (CXL) and Topography-guided PRK (tPRK) for Keratoconus (KCN)
DIAGNOSIS OF KERATOCONUS
CLINICAL EXAMINATION
Step 1: The (Partial, in Regard to Refractive Error Corrected) Topography-guided PRK Technique
Step 2: Collagen Crosslinking (CXL) Procedure
CHAPTER 9:
Photorefractive Keratectomy for Residual Myopia Following Radial Keratotomy
CHAPTER 10:
LASIK
INTRODUCTION
PREOPERATIVE EVALUATION
LASIK SURGICAL TECHNIQUE WITH A MICROKERATOME
LASIK SURGICAL TECHNIQUE WITH A FEMTOSECOND LASER
LASIK POSTOPERATIVE CARE
LASIK Complications
Preoperative Complications
Intraoperative Complications
Postoperative Complications
CHAPTER 11:
Laser-assisted in situ Keratomileusisafter Perforated Keratoplasty
AIM
PATIENTS AND METHODS
RESULTS
CONCLUSION
CHAPTER 12:
Topoguided Customized Ablation Topolink I
PROBLEM
PLANNING
TREATMENT
CONCLUSION
CHAPTER 13:
Wavefront and Topography Guided LASIK
INTRODUCTION
ABERRATIONS
ZYOPTIX LASER
ORBSCAN
ABERROMETER
ZYLINK
RESULTS
DISCUSSION
CONCLUSION
CHAPTER 14:
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
CHAPTER 15:
Customized and Advanced LASIK with Aspheric Ablation Profile
ADVANCED EXCIMER LASER PLATFORM COMPONENTS
Alignment Strategies
Clinical Application (OATz, CATz and OPDCAT)
Retreatments in Symptomatic Eyes
CASE EXAMPLE
SUMMARY
CHAPTER 16:
Topoguided Customized Ablation Topolink II
PROBLEM
PLANNING
TREATMENT
CONCLUSION
CHAPTER 17:
Aspheric Profiles in Laser Refractive Surgery
CHAPTER 18:
Corneal Wavefront LASIK after Penetrating Keratoplasty
TIMING OF LASIK AFTER KERATOPLASTY
TECHNIQUE
CASE STUDY
CONCLUSION
CHAPTER 19:
Zyoptix Laser
INTRODUCTION
ABERRATIONS
ZYOPTIX™ LASER
ORBSCAN
ABERROMETER
ZYLINK™
RESULTS
DISCUSSION
CONCLUSION
CHAPTER 20:
Epi-LASIK
INTRODUCTION
PATIENT SELECTION
PROCEDURE
Surgical Tips
Early Postoperative Period
Advantages–Complications
CONCLUSION
CHAPTER 21:
Epi-LASIK with Mitomycin C
HISTOLOGICAL FINDINGS
PRINCIPLE OF EPI-LASIK
PROCEDURE
INTRAOPERATIVE COURSE
Postoperative Treatment
CLINICAL DEDUCTIONS
CONCLUSION
CHAPTER 22:
One-shot Epithelium-rrhexis: Personal Technique
INTRODUCTION
Questions
Description
CONCLUSION
CHAPTER 23:
Painless Epi-LASIK
SURGERY PROCEDURE
Epitrephine Assisted LASEK Technique
Epi-LASIK Technique
Advantages of Rotational Epikeratome
POSTOPERATIVE MANAGEMENT
Bandage Contact Lens
Eyedrops
CHAPTER 24:
Corneal Wavefront-guided LASIK for “Corblyopia”
A SHORT HISTORICAL ACCOUNT OF TOPOGRAPHY
TOPOGRAPHY AND WAVEFRONTS
A Few Basics
METHODS
Advantages of ORK Corwave (ORK-W)
The Keratron Scout
Steps in Performing a Corneal Wavefront- guided Ablation
ANISOMETROPIC AMBLYOPIA IN CHILDREN
CORBLYOPIA—A NEW ENTITY
Corblyopia, i.e. Corneal Amblyopia
CONCLUSION
CHAPTER 25:
Wavefront-guided Correction of Irregular Cornea
INTRODUCTION TO WAVEFRONT ABERRATION
CORNEAL WAVEFRONT ABERRATIONS
CORNEAL WAVEFRONT AS A GUIDE FOR THE CORRECTION OF IRREGULAR ASTIGMATISM
Basis of Treatment
Clinical Examination
Surgical Technique
Results
Efficacy
Safety
Predictability
Higher Order Aberrations
Total Higher Order Corneal Wavefront
First Order Aberrations
Coma-like Aberrations
Spherical-like Aberration
CASE REPORT
CONCLUSION
CHAPTER 26:
Customized LASIK for Presbyopia: PML™ (Presbyopic Multifocal LASIK) Technique
WHY “CUSTOMIZATION” IN THE LASIK TREATMENT FOR PRESBYOPIA
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 A: Emmetropic-presbyope
Clinical History
Case Example B: Hyperopic-presbyope
Case Example C: Myopic-presbyope
Case Example D: Mixed Astigmatic-presbyope
Short Comments of the Author to the Four Cases
Final Considerations
Brief Note to the Video
CHAPTER 27:
Presby-LASIK
CHAPTER 28:
Crosslinking
INTRODUCTION
SUBJECT
CONCLUSION
CHAPTER 29:
Corneal Collagen Crosslinking in Keratoconus
INTRODUCTION
SURGICAL PROCEDURE
FOLLOW-UP
CLINICAL RESULTS
RISKS AND SIDE EFFECTS
CHAPTER 30:
Corneal Collagen Crosslinking with Riboflavin and Ultraviolet-A Light: Step by Step Technique
INTRODUCTION
TECHNIQUE BACKGROUND
RIBOFLAVIN AND ULTRAVIOLET-A LIGHT
Preparation of 0.1% Riboflavin Solution
Step by Step Technique
Safety
More Research Required
CHAPTER 31:
Transepithelial Crosslinking for the Treatment of Keratoconus
INTRODUCTION
CORNEAL COLLAGEN NETWORKS
PHOTOCHEMICAL CROSSLINKING
RIBOFLAVIN-UVA TREATMENT
CORNEAL EPITHELIUM
CHAPTER 32:
Significance of Epithelial Debridement for Riboflavin Absorption Prior to Riboflavin/Ultraviolet-A (UVA) Corneal Collagen Crosslinkage Therapy
METHODOLOGY OF OUR STUDIES18,19
RESULTS18–19
DISCUSSION
CONCLUSION
CHAPTER 33:
Femtosecond Surgical Laser
INTRODUCTION
AVAILABLE FEMTOSECOND LASER SYSTEMS
Technical Data
Ablation in the Cornea
APPROACHES FOR TISSUE PROCESSING
High Pulse Energies
Low Pulse Energies
Focal Length of the Femtosecond Laser
Patients and Methods
RESULTS
Confocal Microscopy Analysis
Hot Spot of the Femtosecond Laser
Pachymetry
Visual Acuity
Handling
Treatment Cutting Time
Complication
Application of the LDV Femtosecond Laser after Perforated Keratoplasty
New Development in Femtosecond Laser Technology for the Future
CONCLUSION
SECTION II: COMPLICATIONS MANAGEMENT IN CORNEAL REFRACTIVE SURGERY
CHAPTER 34:
LASIK and Its Complications
INTRAOPERATIVE COMPLICATIONS
Incomplete Flap/Irregular Flap
Free Flap/Cap
Thin Flap/Buttonholes
Sliding or Dislodged Flap
Epithelial Defect/Corneal Erosions
Corneal Limbus Bleed and Subconjunctival Hemorrhage
Decentered Ablation
Undercorrection, Regression
POSTOPERATIVE COMPLICATIONS
Diffuse Lamellar Keratitis (DLK)
Flap Striae
Epithelial Ingrowth
Infections Keratitis and Infiltration
OTHERS
Interface Debris and Remnants
Dry Eye
Induced or Iatrogenic Keratectisia
Astigmatism/Irregular Astigmatism
CHAPTER 35:
Corneal Ectasia PostLASIK: The Orbscan Advantage
INTRODUCTION
CORNEAL ECTASIA
SELECTION CRITERIA
PACHYMETRY5
POSTERIOR ELEVATION MAP (FIG. 4)
POWER MAP
COMPOSITE/INTEGRATED INFORMATION
FUTURE THOUGHTS
ACKNOWLEDGMENTS
CHAPTER 36:
Management of PostLASIK Diffuse Lamellar Keratitis
DISEASE ENTITY
CLINICAL FEATURES
Corneal
Ocular
Pathogenesis
Diagnosis
HATSIS CLASSIFICATION OF SANDS OF SAHARA SYNDROME4
Etiology
Toxic Insult
Traumatic Insult
Thermal Insult
DIFFERENTIAL DIAGNOSIS
Delayed Onset
Late Onset or Secondary
Pseudosands
Management – Prevention
MANAGEMENT – TREATMENT
CONCLUSION
CHAPTER 37:
Trauma after Refractive Surgery
TRAUMA IN RADIAL KERATOTOMY
TRAUMA IN PRK
TRAUMA IN LASIK
POSSIBLE MECHANISMS
TRAUMA TO LASIK FLAP
TRAUMA IN SURFACE TREATMENTS
TRAUMA IN PHAKIC IOL IMPLANTS
CONCLUSION
CHAPTER 38:
Surgical Treatment of Epithelial Ingrowth after LASIK
INTRODUCTION
STEP BY STEP—SURGICAL TREATMENT OF EPITHELIAL INGROWTH AFTER LASIK
Step 1: Corneal Marking (Figs 1 and 2)
Procedures
Step 2: Lift Flap from the Edge (Fig. 3)
Procedures
Step 3: Separate the Flap from the Underlying Stroma (Fig. 4)
Procedures
Step 4: Epithelial Scraping (Fig. 5)
Procedures
Step 5: Surface Irrigation (Fig. 6)
Procedures
Step 6: Use Proparacaine or Alcohol (For Recurrent or Severe Epithelial Ingrowth)
Proparacaine
Ethanol
Step 7: Suture the Flap4 (Figs 7 and 8)
Step 8: Adjust the Knots (Figs 9 and 10)
Step 9: Apply Soft Contact Lens
Case report: Severe Epithelial Ingrowth after Trauma
CONCLUSION
CHAPTER 39:
Repairing Multifocal IOL Surprise and Corneal Scar—Refractive Surgery of the Rescue
STEPS OUTLINED BELOW
Steps
CHAPTER 40:
Hypotonic, Hyperthermic (at 55°C) LASIK Flap Ironing and Subsequent 7, 10–0 Nylon Suture Placement for the Management of Severe Post-LASIK Striae
CONCLUSION
CHAPTER 41:
In-flap Simultaneous Collagen Crosslinking (CXL) and Topography-guided PRK (tPRK) for Early Post-LASIK Ectasia—A Novel Technique
CHAPTER 42:
Intacs Implantation with Sequential Collagen Crosslinking Treatment in Postoperative LASIK Ectasia
CXL
Intacs ↑
Enhancement after Implantation of Intracorneal Ring Segments
CHAPTER 43:
Factors Influencing Flap and Intacs Decentration after Femtolaser Application in Normal and Keratoconic Eyes
STATISTICAL ANALYSIS
CHAPTER 44:
Corneoplastics Using Corneal Collagen Cross-linking and Intracorneal Rings for Keratoconus and LASIK Ectasia
COMBINING NEW AND OLD TECHNIQUES
UNFINISHED BUSINESS
Combining Treatments Experiences
Crosslinking and PRK
Pentacam Treatment Plan and Differential Map
SECTION III: LENTICULAR REFRACTIVE SURGERY
CHAPTER 45:
Refractive Lensectomy: A New Concept Arising at the Horizon
INTRODUCTION
Technique Description
CONCLUSION
CHAPTER 46:
Anterior Chamber Phakic IOL with Angle Fixation
ADVANTAGES
HISTORY
Types of Phakic Lens
Morcher GMBH 93 A (Fig. 5)
Baikoff Model ZB5MF (Fig. 6)
Phakic 6 Model 130 (Fig. 7)
Nuvita Baikoff MA 20 (Fig. 8)
Kelmnan Duet (Fig. 9)
Inclusion Criteria
SURGICAL TECHNIQUE
Complications
CONCLUSION
CHAPTER 47:
An Update on Phakic Intraocular Lenses
GENERAL DISCUSSION
Different Types of Phakic IOLs [PIOLs].
HISTORY
Qualities of the Artisan Spheric PIOL
Indications for the Artisan Spheric PIOL
Requirements for the Artisan Spheric PIOL
Contraindications
Surgery for the Artisan PIOL
Anesthesia
Incision
Follow-up
Complications
Preoperative Complication
Intraoperative Complications
Complications of Position of the PIOL
Complications of the Peripheral Iridotomy/Iridectomy
Postoperative Complications
Results of the Spheric Artisan PIOL
ARTISAN TORIC PHAKIC INTRAOCULAR LENS
Surgery for Toric Artisan PIOL
Preoperative Marking of the Enclavation Sites
Anesthesia
Incision
Follow-up
Complications
Intraoperative complications
Complications of Position of the Toric Artisan PIOL
Complications of the Peripheral Iridotomy/iridectomy
Postoperative Complications
Results of the Toric Artisan PIOL
ARTIFLEX foldable Iris clip PIOL
Indications for Use of the Artiflex PIOL
Indications
Contraindications
Surgery
Anesthesia
Incision
Follow-up
RESULTS
Complications
Preoperative
INTRAOPERATIVE COMPLICATIONS
Wound Complications
OVD Complications
Complications of Position of the PIOL
Complications of the Peripheral Iridotomy/Iridectomy
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
CHAPTER 48:
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
CLINICAL EXAMPLES
CONCLUSION
CHAPTER 49:
Piggybacking for Advanced Hyperopia
CHAPTER 50:
Is This Patient a Candidate for a Multifocal IOL?
CHAPTER 51:
Outcomes of Mixing and Matching Tecnis/ReZoom
OUTCOMES OF MIXING AND MATACHING TECNIS/REZOOM
CHAPTER 52:
Custom ICLs
INTRODUCTION
THE CONCEPT OF CUSTOM PHAKIC IOL
Custom Sizing the Overall Length
CONCLUSION
CHAPTER 53:
Crystalens HD: The Accommodative IOL Technique
CHAPTER 54:
ICL Pearls
CHAPTER 55:
An Update on Other Refractive Procedures
COLLAGEN CROSS-LINKAGE WITH RIBOFLAVIN (C3R)
Procedural Details
IMPLANTABLE CONTACT LENS ICL
CHAPTER 56:
Complication and Contusion after Phakic IOL
INTRODUCTION
ANTERIOR CHAMBER PHAKIC IOLs (FIG. 1)
Endothelial Complications and Anterior Chamber Depth
Pigment Dispersion and Lens Deposits
Chronic Inflammation and Uveitis
Size-related Complications Pupil Ovalization and Iris Retraction (Fig. 2)
Induces Astigmatism
Glare and Halos
Glaucoma
Cataract Formation
IRIS-FIXATED ANTERIOR CHAMBER PHAKIC INTRAOCULAR LENSES (FIG. 7)
Complications of Iris-Supported Phakic IOLs5
Endothelial Cell Loss and Anterior Chamber Depth
Chronic Inflammation and Uveitis
Pupil Ovalization and Decentration
Glare and Halos
Glaucoma
Cataract Formation
CASE REPORT (FIGS 11 AND 12)
DISCUSSION
Posterior Chamber Phakic Intraocular Lenses14 (Figs 13 and 14)
Cataracts have always been the main concern
Pupillary Block, Acute Glaucoma andMalignant Glaucoma
CONCLUSION
SECTION IV: RECENT ADVANCES IN REFRACTIVE SURGERY
CHAPTER 57:
An Update on Laser Refractive Surgery
FEMTOSECOND LASER
EPILASIK
CUSTOMIZED LASIK / C-LASIK
Corneal Wavefront Aberrometry
CHAPTER 58:
An Update on Corneal Inlays for Presbyopia
SYNTHETIC KERATOPHAKIA HISTORY
Features and Surgical Technique
IntraLase Pocket Benefits
Acufocus Inlay Features
Protocol for Acufocus Implantation in Emmetropes Presbyopic Patients
Surgical IntraLase, Surgical Technique Step by Step (Figs 12 to 18)
Biovision Inlay, Features and Surgical Technique
Sequence of Biovision Invue Inlay implantation in a Pocket Carved with IntraLase Femtosecond Laser (Figs 22 to 25)
THE PRESBYLENS™ CORNEAL INLAY: AN ADJUSTABLE DEVICE FOR PRESBYOPIA
The Pesbylens™ Corneal Inlay (CI)
Corneal Inlay Results
Acufocus ACI Clinical Results
Biovision Invue Results
Presbylens Inlay Results
The New Presbylens Design
CHAPTER 59:
Surgical Treatment of Keratoconus and LASIK Ectasia with Intrastromal Corneal Ring Segments (Keraring®)—Custom Keraring Implantation Using IntraLase
SURGICAL TECHNIQUE AND SPECIFICATIONS
Surgical Technique
How to Make Keraring Implant Surgical Plan
Manual Dissection and Implantation Technique9
Keraring IntraLase Technique Advantages
Keraring IntraLase Procedure Step by Step
NOMOGRAMS AND CONSULTANCY
Keraring Specifications (Fig. 16)
Set of Instruments (Fig. 20)
Postoperative Care
Custom Keraring and IntraLase Topographic and Refractive Examples
COMPLICATIONS
Postoperative Complications
Keraring and IntraLase conclusionOrthopedic or Refractive Procedure
CHAPTER 60:
Strategic Planning in Topography-guided Ablation of Aberrated Eyes and after Laser Refractive Surgery
LASIK AFTER PENETRATING KERATOPLASTY
GENERAL SURGICAL TECHNIQUE
GRAFT ENDOTHELIAL INTEGRITY
LASIK AFTER OCULAR TRAUMA
LASIK AFTER RADIAL OR ARCUATE KERATOTOMY
CHAPTER 61:
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
CHAPTER 62:
Laser Surgery in Post RK Cases
CHAPTER 63:
Laser PRK for Keratoconus
CHAPTER 64:
Recent Advances in Corneal Refractive Surgery
INTRODUCTION
ADVANCES IN FLAP CREATION TECHNOLOGY
MICROKERATOMES
FEMTOSECOND LASER
ADVANCES IN EXCIMER LASER PLATFORMS
ADVANCES IN LASER ABLATION PROFILE
ADVANCES IN SURFACE ABLATION TECHNIQUES
SUMMARY
CHAPTER 65:
Refractive Surgery and Glaucoma
INTRODUCTION
GLAUCOMA AFTER LASER ASSISTED IN SITU KERATOMILEUSIS
Steroid-induced Interface Fluid Syndrome after LASIK
Acute Optic Neuropathy after LASIK
GLAUCOMA ASSOCIATED WITH PHAKIC INTRAOCULAR LENS IMPLANTATION
Trabecular Block by Viscoelastic
Pupillary Block
Malignant Glaucoma
Angle Closure
Pigment Dispersion
Steroid-induced Glaucoma
CONCLUSION
CHAPTER 66:
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
CLINICAL APPLICATIONS
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
cTEN™—Custom Transepithelial “No-touch, One-step, All-laser” Treatment Strategy
Variable Width Constant Slope Transition Zone
CLAT™—Corneal Lamellar Ablation for Transplantation
iRES™—High Resolution, Ultra-fast Custom Refractive and Custom Therapeutic Laser
Constant Frequency per Area™
Clinical Applications
CHAPTER 67:
Solid State Laser in Refractive Surgery and Advances in Surface Ablation Techniques
THE PULZAR Z1 SOLID STATE LASER
213 NM WAVELENGTH
Benefits of the 213 nm Wavelength Include
SPECIAL FEATURES AVAILABLE TO THE PULZAR Z1
Eye Tracking
ZTRAK Includes
Gaze Tracking
ZTRAK
Gaze Tracking
Unique Advantages of Limbus Eye Tracking (PULZAR Z1 Tracking System)
CYCLOROTATION
0.6 MM FLYING GAUSSIAN BEAM SPOT
CRYSTALSCAN
Customized Treatments with Pulzar Z1
ZCAD –The Intelligent Surgical Planning Software
TRACEY WAVEFRONT ANALYZER
Data Displays
Other Advantages of Tracey
Tracey and CustomVis Pulzar Z1
ADVANCE SURFACE ABLATION
Corneal Wound Healing
Epithelial Healing
Stromal Healing
Growth Factors and Wound Healing
Regeneration of Corneal Nerves
SUMMARY
Surgical Techniques
PRK
LASEK (Laser assisted sub-epithelial keratectomy)
Epi-LASIK
Bandage Contact Lenses (BCL)
Complications
Corneal Haze and Opacification
Grades of Corneal Haze
Dry Eye
Epithelial Complications
Under- and Over-correction
Infectious Keratitis
Comparison of 193 nm and 213 nm Wavelengths
Importance of Corneal Hydration during Ablation
Tissue Hydration Study on Surface Treatments
Treatment Times/Ablation Rates
HISTOPATHOLOGICAL COMPARISON OF PRK IN RABBITS
Introduction
Methods
Analysis
DISCUSSION
CONCLUSION
THE BOTTOM LINE
CHAPTER 68:
Prophylactic Collagen Crosslinking in High-risk Femtosecond Assisted-LASIK a Novel Technique
METHODS
CONCLUSIONS
CHAPTER 69:
Simultaneous Prophylactic Collagen Cross-linking (CXL) following High-risk Topography-guided PRK (tPRK)
BACKGROUND
SURGICAL METHODS
Step 1-The Topography-guided PRK Technique
Step 2-Collagen Cross-linking (CXL) Procedure
CONCLUSIONS
CHAPTER 70:
Trioptics
CHAPTER 71:
Corneal Collagen Crosslinking with Riboflavin (C3R) Combined with Intrastromal Ring Segment Implantation and Overnight Contact Lens Molding in Keratoconus
INTRODUCTION
PURPOSE, METHODS AND MATERIALS
LINK to the Video
LINK to the Video
RESULTS
DISCUSSION AND CONCLUSION
CHAPTER 72:
Reshaping Keratoconus: Laser PRK followed by Corneal Crosslinking
GULANI CLASSIFICATION SYSTEM FOR LASER SURGERY IN KERATOCONUS
Among surgical options presented in the current times:
Here, we need to balance our desire to provide an enhanced lifestyle with our honest intention to keep safety for these patients utmost in our minds.
THIS IS WHERE I FIND A PLACE FOR THE EXCIMER LASER
Also with the application of Collagen Crosslinking (C3R), we may be able to arrest these keratoconic corneas after Laser Surgery in the final shape created to prevent progression in the future
Gulani Nordan Criteria for Laser PRK in Keratoconus:
Discussion and Results
C3-R® (COLLAGEN CROSSLINKING)
BOXER WACHLER 10 STEP C3-R® PROTOCOL
CHAPTER 73:
Advances in Corneoplastique™: Art of Laser Vision Surgery
CORNEOPLASTIQUE™ IN ACTION
Here are its components
CHAPTER 74:
Future of LASIK Surgery
ADVANCED TECHNOLOGIES
SURFACE TREATMENT VS LASIK
LENTICULAR REFRACTIVE SURGERY
INDEX
TOC
Index
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