REFRACTIVE SURGERY
Capt dr shoaib Muhammad
INTRODUCTION
• A RANGE OF PROCEDURES

AIMED AT CHANGING
REFRACTION OF THE EYE BY
ALTERING THE CORNEA AND / OR
CRYSTALLINE ...
CORRECTION OF MYOPIA
• CORNEAL SURGERY

– RADIAL KERATOTOMY
• RADIAL INCISIONS IN PERIPHERAL CORNEA
– PHOTOREFRACTIVE KERA...
• LENS SURGERY
–
–

CLEAR LENS EXTRACTION
PHAKIC POSTERIOR CHAMBER
INTRAOCULAR LENS IMPLANTATION
– PHAKIC ANTERIOR CHAMBER...
APPEARANCE FOLLOWING
RADIAL KERATOTOMY
APPEARANCE FOLLOWING LASER
THERMAL KERATOPLASTY
CORRECTION OF HYPERMETROPIA

• CORNEAL SURGERY

– PRK
• CAN CORRECT LOW DEGREES OF
HYPERMETROPIA

– LASIK
• CAN CORRECT UP...
CORRECTION OF
ASTIGMATISM
• CORNEAL SURGERY

– ARCUATE KERATOTOMY
• MAY BE COMBINED WITH COMPRESSION

SUTURE PLACED IN PER...
PHOTOREFRACTIVE
KERATECTOMY

• PERFORMED WITH EXCIMER LASER
• MYOPIA TREATED WITH ABLATING
THE CENTRAL ANTERIOR CORNEAL
SU...
PRINCIPLES OF
PHOTOREFRACTIVE
KERATECTOMY
FOR MYOPIA
TECHNIQUE OF PRK
• VISUAL AXIS MARKED
• PATIENT FIXATES AT AIMING
BEAM OF THE LASER
• LASER APPLIED TO ABLATE
ONLY BOWMAN ...
APPEARANCE DURING
PRK
COMPLICATIONS OF PRK
•
•
•
•

SLOW HEALING EPITHILIAL DEFECTS
CORNEAL HAZE
POOR NIGHT VISION
REGRESSION OF REFRACTIVE CORR...
SUBEPITHELIAL CORNEAL
HAZE FOLLOWING PRK
Excimer Laser Epithelial
Keratomileusis(LASEK)

Corneal epithelium is loosened and set aside, or

removed, refractive pro...
LASER IN-SITU
KERATOMILEUSIS
• CURRENTLY MOST FREQUENTLY

PERFORMED REFRACTIVE PROCEDURE

• CAN CORRECT
–
–
–

HYPERMETROP...
CORNEAL FLAP CREATED
WITH A KERATOME DURING
LASIK
COMPLICATIONS OF LASIK
• OPERATIVE FLAP-RELATED
–
–
–
–
–

BUTTONHOLES
THIN FLAPS
FLAP AMPUTATION
INCOMPLETE OR IRREGULAR ...
WRINKLED FLAP FOLLOWING
LASIK
PRK vs. LASIK

Same destination; Different journey
PRK

LASIK

Day one:
“Oowww!”
Less surgical risk
Slower recovery
80% 20...
YOU

THANK
Refractive surgery   copy
Refractive surgery   copy
Upcoming SlideShare
Loading in...5
×

Refractive surgery copy

372

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
372
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
48
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Refractive surgery copy

  1. 1. REFRACTIVE SURGERY Capt dr shoaib Muhammad
  2. 2. INTRODUCTION • A RANGE OF PROCEDURES AIMED AT CHANGING REFRACTION OF THE EYE BY ALTERING THE CORNEA AND / OR CRYSTALLINE LENS • REFRACTIVE ERRORS CORRECTED INCLUDE MYOPIA, HYPERMETROPIA AND ASTIGMATISM
  3. 3. CORRECTION OF MYOPIA • CORNEAL SURGERY – RADIAL KERATOTOMY • RADIAL INCISIONS IN PERIPHERAL CORNEA – PHOTOREFRACTIVE KERATECTOMY – LASER-IN-SITU KERATOMILEUSIS (LASIK) – INTRASTROMAL PLASTIC RINGS • CAUSE CENTRAL CORNEAL FLATTENING
  4. 4. • LENS SURGERY – – CLEAR LENS EXTRACTION PHAKIC POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION – PHAKIC ANTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION
  5. 5. APPEARANCE FOLLOWING RADIAL KERATOTOMY
  6. 6. APPEARANCE FOLLOWING LASER THERMAL KERATOPLASTY
  7. 7. CORRECTION OF HYPERMETROPIA • CORNEAL SURGERY – PRK • CAN CORRECT LOW DEGREES OF HYPERMETROPIA – LASIK • CAN CORRECT UPTO 4 D – LASER THERMAL KERATOPLASTY • HOLMIUM LASER • LENS SURGERY – PHAKIC INTRAOCULAR LENS IMPLANTATION AT AN EARLY STAGE
  8. 8. CORRECTION OF ASTIGMATISM • CORNEAL SURGERY – ARCUATE KERATOTOMY • MAY BE COMBINED WITH COMPRESSION SUTURE PLACED IN PERPENDICULAR MERIDIAN – PRK • CAN CORRECT UPTO 3 D – LASIK • CAN CORRECT UPTO 5 D • LENS SURGERY – USING A TORIC INTRAOCULAR LENS IMPLANT – POSTOPERATIVE ROTATION OF IMPLANT
  9. 9. PHOTOREFRACTIVE KERATECTOMY • PERFORMED WITH EXCIMER LASER • MYOPIA TREATED WITH ABLATING THE CENTRAL ANTERIOR CORNEAL SURFACE • 10 MICROMETER ABLATION CORRECTS 1 D OF MYOPIA • CAN CORRECT – MYOPIA UPTO 6 D
  10. 10. PRINCIPLES OF PHOTOREFRACTIVE KERATECTOMY FOR MYOPIA
  11. 11. TECHNIQUE OF PRK • VISUAL AXIS MARKED • PATIENT FIXATES AT AIMING BEAM OF THE LASER • LASER APPLIED TO ABLATE ONLY BOWMAN LAYER AND ANTERIOR STROMA • TAKES USUALLY 30 – 60 SECONDS
  12. 12. APPEARANCE DURING PRK
  13. 13. COMPLICATIONS OF PRK • • • • SLOW HEALING EPITHILIAL DEFECTS CORNEAL HAZE POOR NIGHT VISION REGRESSION OF REFRACTIVE CORRECTION • UNCOMMON PROBLEMS INCLUDE – – – – – – – DECENTRED ABLATION SCARRING IRREGULAR ASTIGMATISM HYPOASTHESIA STERILE INFILTRATES INFECTION ACUTE CORNEAL NECROSIS
  14. 14. SUBEPITHELIAL CORNEAL HAZE FOLLOWING PRK
  15. 15. Excimer Laser Epithelial Keratomileusis(LASEK) Corneal epithelium is loosened and set aside, or removed, refractive procedure is performed with the excimer laser (PRK), Finally epithelial layer is brought back to recover the cornea again and held in place Indications  Myopia up to – 6.0 diopters  Hypermetropia up to + 3.0 diopters  Astigmatism up to 3.0 diopters Advantage  Less glare problem than PRK
  16. 16. LASER IN-SITU KERATOMILEUSIS • CURRENTLY MOST FREQUENTLY PERFORMED REFRACTIVE PROCEDURE • CAN CORRECT – – – HYPERMETROPIA OF UPTO 4 D ASTIGMATISM UPTO 5 D MYOPIA OF UPTO 12 D • TO PREVENT CORNEAL ECTASIA, A RESIDUAL CORNEAL BASE OF 250 MICROMETER THICKNESS MUST REMAIN AFTER THE FLAP HAS BEEN CUT AND TISSUE ABLATED
  17. 17. CORNEAL FLAP CREATED WITH A KERATOME DURING LASIK
  18. 18. COMPLICATIONS OF LASIK • OPERATIVE FLAP-RELATED – – – – – BUTTONHOLES THIN FLAPS FLAP AMPUTATION INCOMPLETE OR IRREGULAR FLAP RARELY CORNEAL PERFORATION • POSTOPERATIVE – WRINKLING, DISTORTION OR DISLOCATION OF FLAP – EPITHELIAL INGROWTH UNDER THE FLAP – DIFFUSE LAMELLAR KERATITIS – PERIPHERAL CORNEAL INFILTRATES
  19. 19. WRINKLED FLAP FOLLOWING LASIK
  20. 20. PRK vs. LASIK Same destination; Different journey PRK LASIK Day one: “Oowww!” Less surgical risk Slower recovery 80% 20/20 Haze No flap 0.2 – 0.3% risk visual loss (>2 lines) Day one: “Wow!” Greater surgical risk Quicker recovery 80% 20/20 No haze Flap 0.2 – 0.3% risk visual loss (>2 lines)
  21. 21. YOU THANK
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×