Refractive surgery copy
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This document discusses various refractive surgery procedures aimed at correcting refractive errors such as myopia, hyperopia, and astigmatism by altering the cornea and/or crystalline lens. It describes procedures such as radial keratotomy, photorefractive keratectomy (PRK), laser-in-situ keratomileusis (LASIK), and phakic intraocular lens implantation. It provides details on how each procedure is performed and discusses complications that can occur. The document compares PRK and LASIK, noting that while LASIK recovery is quicker, it carries greater surgical risk due to creation of a corneal flap. Both procedures have around a 0.2-0.3% risk of losing more than
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Refractive surgery copy
- 2. REFRACTIVE SURGERY Capt dr shoaib Muhammad
- 3. 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
- 5. 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
- 6. • LENS SURGERY – – CLEAR LENS EXTRACTION PHAKIC POSTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION – PHAKIC ANTERIOR CHAMBER INTRAOCULAR LENS IMPLANTATION
- 8. APPEARANCE FOLLOWING LASER THERMAL KERATOPLASTY
- 9. 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
- 10. 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
- 11. 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
- 13. 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
- 15. 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
- 17. 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
- 18. 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
- 19. CORNEAL FLAP CREATED WITH A KERATOME DURING LASIK
- 20. 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
- 22. 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)
- 23. YOU THANK