femtolasik

1. B/
Dr. Amr Mounir
Lecturer of Ophthalmology
Sohag University

2. Background
Femtosecond (FS) laser is an
infrared laser with a wavelength
of 1053nm.
Works by producing
photodisruption or
photoionization of the optically
transparent tissue such as
the cornea.
FS laser has pulse duration in

3. Background
Femtosecond laser differs significantly from
Yag Laser in the amount of collateral
damage they cause. Nd:YAG laser has a
pulse duration in the nanosecond range (10-9
second) where as FS laser has pulse
duration in the femtosecond range
(10-15 second).

6. Femtosecond laser in ophthalmology
Uses:
•Femtolasik
•Femtosecond cataract
surgery
•Femtokeratoplasty
•Femtosecond laser
in keratoconus

7. Femtolasik

8. Sohag, Egypt, 2013

9. Femtolaser emission

10. Patterns of femtosecond laser ablation

11. Flap Separation

12. Advantages: Optimal safety

13. Advantages:
Optimal safety
No flap related complications e.g.: free cap,
button holes, incomplete cuts
- Thinner flap:
Uniform thin flaps with no liability of
complications
Thin flaps leads to large stromal bed with less
liability for ectasia

14. Advantages: Flap Design

15. Advantages:
Flap Design
Large flap diameter : in HMT, in
custom ablation
Hinge : superior or nasal if there is
cylinder Hinge angle can be also modified

17. Flap shape
Femtosecond
laser Flap:
Planner Flap →
less complications
→ Less Dry Eye
M2 flap : Meniscus
flap

18. Flap edge
Flap edge :
Femtosecond laser can
create a corneal flap that
has edges that enable the
flap to fit more securely
in place, (inverted Side
cut) > 90 degree “
beveled edge”
Better

19. Advantages: less IOP elevation

20. Advantages:
less IOP elevation
•FemtosuctionelevatesIOP to about
18:25 mm.Hg
•Suction ring in conventionalLasik
elevates IOP to about 70: 80
mm.Hg
•Better in High myopia

21. Complications that can occur with a
femtosecond laser as well as a
microkeratome
Flap striae (wrinkles in the flap)
Diffuse lamellar keratitis, DLK
(inflammation under the flap)
Epithelial ingrowth

22. Complicationsrelated to Femtolasik only
Opaque bubble layer:
Gas bubbles in the
intralamellar space,
above and below the
resection plane.
Early OBL tends to
spread ahead of the
raster pattern

23. T
ransient light sensitivity syndrome (TLSS):
•Patients can present
with moderate to
extreme light
sensitivity.
•Caused by keratocyte
activation or gas
migration to the
corneal periphery

24. Vertical gas breakthrough

26. What are the
real problems we
face in
Femtolasik ???

27. Medical problems
Lengthy
procedure
especially in
inexpert hand.

28. Subconjunctival
hemorrhage

29. Technology
problems

31. Financial aspect

33. When to do
Femto Lasik
?????

34. Indications:
1- Normal steep cornea : No
risk of button hole

35. Indications:
2. Flat cornea: No risk of
free cap

36. Indications:
3- High Myopia :
- Controlled depth 90 um
(Precise depth)
- Less effect in the posterior
segment

37. When large flap
diameter is needed :
in HMT,
in custom ablation

38. Home Message

39. • Femtolasik is a relatively new procedure
with many advantages.
• Most important advantages include
optimal safety, with less complications,
flap design ability and less effect in the
posterior segment. is that it is
an
preserve it for
• Our most Femtolasik
problem expensive
technique so we
indicated cases.

40. Thank
You