This presentation describes all indications and limitations of femtosecond laser surgery.....you can watch the illustrated video presentation in the following link: https://youtu.be/vCwu-_hpWxA

1. BY
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 the
femtosecond range (10-15 second)

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
- Precise depth

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 Biomechanics
M2 flap : 40: 70 degree

19. Advantages: less IOP elevation

20. Advantages:
less IOP elevation
•Femtosuction elevates IOP to about 18:25
mm.Hg
•Suction ring in conventional Lasik 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. Complications related 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. Transient light sensitivity syndrome (TLSS):
•Patients can present with
moderate to extreme light
sensitivity.
•Caused by keratocyte
activation or gas migration
to the corneal periphery
•Transient phenomenon

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.
• Our most Femtolasik problem is that it is an
expensive technique so we preserve it for
indicated cases.

40. Thank
You