Глазная Хирургия Методом Ласик
The word LASIK is an abbreviation obtained with the initials of Laser Assisted in-Situ Keratomileusis. LASIK method is the ultimately perfected form of techniques by using laser technology which were actually initiated in 1949s and called lamellar refractive surgery. Within this technique, the principal is removing the epithelium layer located at the frontmost of the corneal tissue, and the Bowman layer (a layer without the characteristic of self-perpetuation) with a device called microkeratom or femtosecond laser (flap). Afterwards, Excimer Laser performs the shaping process on the middle layers and when it is completed the removed flap is adhered on its original place. The flap is well-adhered due to the liquid pump in the cornea.
Lasik method is a two phased process comprising of flap shaping and reshaping of cornea with excimer laser. For flap formation, power-operated microkeratom which is a special blade or femtosecond laser is used. Different terms are used depending on modifications which result in incomprehensibilities: iLasik, sLasik, zLasik, FemtoLasik, etc. Consequently, the basic principle of the process is same for all. Also, Excimer lasers of different brands are available on the market.
Will LASIK prevent any other future treatment or operation regarding my eyes?
No. If a person who has undergone Lasik thereafter requires cataract, Glaucoma or retinal surgery, previously having been treated by lasik is not an obstacle for the treatment of those.
Am I eligible for LASIK or not?
First of all, you have to be subject to a detailed eye examination. If you use contact lenses, you have to quit using soft lenses 1 week before and hard and semi hard lenses 3 weeks before the examination. The values should be accurately measured in examinations with and without drops. Afterwards, corneal thickness is determined by corneal topography and pachymetry; wavefront measurement is performed by aberometer and pupil size is detected with pupillometer, and the nature of eye is examined in details. As a result of these examinations and investigations, your doctor will decide whether you are eligible for laser or not.
How is the examination performed?
Exhaustive measurements are performed. Our patients are informed about the procedure at the end of the examination. The patients should spare at least three days, the first of which is for the examinations and investigations; the next is for the treatment and the last is for the control.
How is the procedure applied before treatment?
The patients using soft contact lenses and gas-permeable semi-hard lenses should take their lenses off at least 7 days and 3 weeks, respectively, before the treatment.
How is the procedure applied during treatment?
You will be administered a tranquilizer about 30 minutes before the operation. This smoothes away the excitement for operation and enhances the conformity. Shortly before entering into the laser room your eyes are administered anesthetic drops to ensure that you will not feel any discomfort or pain. When you lie down on the laser table your eyelids are wiped with an antiseptic solution and covered by a plastic cover. A specific wire is used to separate your eyelids. Thus, you are not able to close your eyes even if you want to. Afterwards, you will see the bright light of the microscope and a green punctuate light in the middle of it. Your doctor will ask you to stake in that green light during operation. As the laser is focused on the eye during the treatment, it will follow the eye up even if it moves. The fact that you are comfortable and at ease will relatively shorten the duration of the operation. Treatment duration is 4-5 minutes for each eye.
How is the procedure applied after treatment?
Antibiotic drops are administered in your eye after the operation and you have to wear protective glasses to avoid dusts. These glasses are taken off the following day. Blurred vision is an absolutely natural situation. You may have a feeling of burning, stinging and watering in your eyes for a few hours. Pain is rare; so, it is possible to relieve it with a simple analgesic in case it occurs. Avoid touching, scratching and rubbing your eyes. Avoid having a bath and washing your face. You should not watch television or read anything.
Administer you antibiotic drops as recommended by your doctor. The day following the treatment, our patients will necessarily be subject to a brief check in our institute as it is highly significant. Following the control, the people whose treatment is completed will go on their daily lives.
The drops are to be used for 1 week and then they are discontinued.
Avoid make-up for 1 week.
Avoid swimming pools and sea for 2 weeks.
You may have a bath or take a shower following the control on the next day of the treatment. However, you should avoid soap and shampoo getting in your eyes.
What is Wavefront Technique?
Wavefront Technology is also called Customized treatment – eagle eye technique.
The purpose of the standard Lasik technique is to eliminate the diopter value.
However, the purpose is to enhance the quality and level of vision as well as to reduce the night vision problems. Particularly, more qualified and better vision is ensured that can not be provided with standard therapy for the patients with corneal irregularity who are not able to see well depending on amblyopia.
Wavefront technology has been used to take more clear pictures space with telescope in the area of astronomy for years.
The waves of light enter parallelly in our eyes, but as they go through pane, lens and cornea the light here returns back wavily resulting in deviations (aberrations).
Three dimensional image is transferred to the laser via a disk. The maps which are recorded with aberometry are personal and they are exactly footprints.
How is Wavefront Applied?
All layers of the eye are measured using a device called Wavefront Analyzer (Aberometry) and the deviations and irregularities here are mapped as per each eye. This map is then transferred to the laser device and special treatment is planned for each eye.
Since Wavefront maps are different for each individual footprints, the treatment is considered customized for the patients.
What is Excimer Laser?
“Excimer” is the derivate of the words of excited and dimmer and Excimer Laser is a laser radiating ultraviolet light at 193nm obtained by the stimulation of Argon and fluoride gases. The laser, initially being used in plastic industry and for the production of electronically integrated circuits, attracted the attention of the medicine world due to its precision and started to be used for the first time in 1988 for the myopia treatment over eyes in the United States.
The characteristics of Excimer Laser
If you have read the descriptions regarding the refraction impairment such as myopia or hypermetropia, you may remember that the anteroposterior length of the eye and the changes in the corneal curve result in such situations. The way to eliminate these impairments completely is possible via changing the corneal curve since we are not able to change the length of the eye (at least for now). We are able to perform this by using Excimer Laser which is the most precise lancet invented by the human.
Excimer Laser breaks off the molecular bonds of the corneal tissue performing shaving and gives the cornea a new shape just a sculptor. This process is performed with a high precision. With each touch of Excimer Laser on the cornea 0.25 microns tissue (1/400 of the thickness of strand) is shaved.
Фемтосекундный Лазерный Метод
Femtosecond Lasers are commonly used as well as Excimer lasers as microkeratom for lasik treatment.
A wide number of laser beams compressed into a very short period of time (15.000 points per second) is focused on the required point on the cornea with an accuracy of micron level. Totally computer-controlled femtosecond laser forms 1-3 micron bubbles containing carbon dioxide and water on the corneal layer which ensure the disintegration of tissues. The device Femtec is used in our institute.
Flap Formation with laser (Incision without blades)
The first stage of the lasik method is to form a flap of 90-120 microns on the corneal layer. Flap formation had been done with mechanical microkeratom blades for years.
However, flap is formed completely by Femtosecond laser without using any blades in femtolasik method. Femtosecond laser beams form a incision in accordance with the diameter, thickness, deepness and direction planned. Therefore, it is ensured that the flap incision is done securely in the thin cornea, small eyes and the eyes that have been previously operated.
Thus, the risk of incision complications is reduced such as free flap, buttonhole, incomplete flap that are seen with keratome. The thickness of flap may deviate +- 20 microns in keratomes as it is possible to obtain the required thickness and size of flap with femtosecond laser as well as the healing is quicker due to proper flap.
Intracorneal ring formation (Femtoring)
With regards to the operation ring replacement (PLASTIC Rings-intacs) in cornea in patients with keratoconus, a tunnel is prepared in the cornea. This tunnel may be formed mechanically under general anesthesia or by femtosecond laser. The advantage of femtosecond laser is that the rings are prepared as required in terms of deepness and length in a relatively shorter period of time as well as the fact that the process is performed under local anesthesia rather than the general one.
Arcuate incision with Femtosecond Laser
It is the method in which arc-shaped incision is done on the axes in opposite to the cornea in people with astigmatism up to the diopter value of 3.0.
The incision was used to be done with a diamond blade or manually. However, it is done more easily and in a shorter period of time by Femtec Femtosecond laser.
Who are eligible for Arcuate Keratotomy?
– Patients with eyes with hypermetropic astigmatism which are ineligible for laser
– Patients with posttraumatic astigmatism which is ineligible for laser
– Patients with astigmatism developed following Cataract Surgery
– Patients with astigmatism developed following keratoplasty (corneal transplant)
– Femtosecond laser provides good results by performing arcuate incisions in astigmatic eyes which have been subject to Lasik, Lasek and PRK. It is a method specifically preferred for thin corneas since flap regeneration, flap removal or tissue shaving are not required.
It is an native process of excimer laser which is widely used in our institute due to the fact that it takes a shorter period of time in comparison with incision with a blade; that it ensures that the required deepness and length are obtained, and that it is a painless method which heals up quickly.
Keratoplasty (Corneal transplant) with Femtosecond Laser
Both the cornea which is to be transplanted and the cornea tissue which will be exchanged are cut out with Femtosecond Laser as per the required size and shape in a very short period of time. The process of incision with a blade takes a long time and it may result in post-operative development of high astigmatism in the patient or rejection of the transplanted tissue due to the improperness of the incision. Incision by laser is widely used due to the fact that it is safer minimizing the risks.
During a standard cornea transplant operation the receptor and donor corneas are cut out with a blade. Yet, this is a long and rough process. Now, the duration of cornea incision has been shortened by Femtosecond Laser and also it has been rendered possible to form the cornea and its bed to be transplanted with the laser as per the required shape. Therefore, the risks of astigmatism have been reduced following tissue rejection and transplant.
Intrastromal Presbyopia Treatment - Intractor
This method of treatment is a new method performed with femtosecond laser. It was developed by Dr. Ruiz in 2007 in Colombia. At the beginning of 2008, Dr. Sinan Göker began to apply it. FEMTEC femtosecond laser used for this treatment is the only laser suitable for the treatment.
Intrastromal presbyopia treatment is performed without cutting out the cornea and thinning the corneal tissue. Therefore, the duration for this therapy is 20 seconds. It does not have risks as infection and dry eye. It may also be applied in thin and dry eyes securely.
Shortly after the therapy, the patient gets back to one’s home and continues to the normal life.
The other advantages of this method are that they could be applied in both eyes un other methods and it improves near sight without deteriorating the distance sight.
It has been applied in 300 patients so far with a success rate of 80% for which the results were monitored to be permanent as consequence of a follow-up of 1.5 years.
Fakik Intraocular Lens (Fakik IOL)
The operation of intraocular lens replacement may be performed for the eyes that are not eligible for laser in case the eye structure is considered as suitable.
They are the lenses replaced in front of or behind the iris (the colored part) intraocularly instead of contact lenses. It is an native method of laser we apply in the eyes which are not eligible for excimer laser techniques due to thin cornea or very high diopter value.
Nowadays, the lenses replaced behind the iris (ICL, ArtiFlex, etc.) are used widely.
How is the treatment performed?
The eye pupil is enlarged or minimized before the operation with drops as per the lens type and anesthetic drops are used to narcotize the eye surface. The lens is folded being placed into the eye through a small incision on the cornea. Rarely, incision is replaced by a suture. Following the process that takes totally 10 minutes the patient is ready to go home with the eye covered. The next day, the dressing is removed.
Risks and Complications:
– Increased intraocular pressure (Eye Tension)
– Belated development of cataract
– Retina Decollement
Refractive Lens Exchange
If laser can not be applied in the eyes of patients who are not very young, the lens of the patient is removed and monofocal (only for distance sight) or multifocal (distant – near) intraocular lens is replaced as in cataract operation.
It is a treatable vision problem that is usually seen with increasing age. Cataract can be treated easily and successfully with developing surgery methods and intraocular lens technologies.
Cataract is usually seen related to aging. The intraocular lens that normally should be transparent loses its transparency, becomes opaque and changes color; as a result, the patient starts experiencing problems related to vision.
It is treatable; however, the treatment is only a surgical one.
What should you do?
You should contact your doctor and have an eye examination.
What could happen if it is not treated?
Vision problems in near and far, changes in eye pressure... Because cataract is an obstacle for retina examinations, it makes it difficult to diagnose other eye diseases.
How will your surgery take place?
Your eyes will be anaesthetized with drops. The surgery will be done with PHACO EMULSIFICATION, which is currently the most developed method. The lens that will be placed in the eye will be an FDA or CE approved foldable lens. The advantage of this method is that it will not require stitches because it is done with a small incision. You can return your home the same after the surgery after a short stay at the hospital. You will need to come back for a follow-up and we will explain you how you should use your medication. Each eye is treated on a different day, typically 2-3 days apart.
Important elements affecting the success of cataract surgery
Experience of the doctor and their familiarity with cataract.
The technique used during the surgery, applying PHACO, for the lens to be placed in the eye to be FDA approved, multi-functional and foldable.
Surgery Preparation: Eye measurements to calculate the correct intraoculer lens.
Outpatient Surgery: Same-day procedure with a local anesthetic such as a eye drops.
Follow-up Visits: First day after surgery than one month approximetly, as needed.
Using of the eye drops for 15 days.
How can I go back to work?
Recovery time varies depending on a different factors such as treatment type and your working environment.Usually we are recommending rest of one week and as you feel comfortable with your vision.You can return to work within 2-3 days after cataract surgery unless your work environment is very dusty or dirty.
Supracor is a laser treatment for people who require an improvement in distance and reading vision. Supracor is an effective treatment that aims to improve both near and distance vision in both eyes. The eye is prepared in the same way as traditional LASIK surgery and the SupraCor treatment is delivered by the same laser used in LASIK and LASEK surgery.
Supracor is a new generation of bilateral presbyopia treatment that can give your patients the spectacle free lifestyle they are seeking. SUPRACOR is unique multifocal ablation profile and sophisticated algorithm provide the expected near addition while minimizing the induction of undesired aberrations within the pupil. Designed for the full refractive treatment range, SUPRACOR is also potentially suitable for patients with previous LASIK surgery.
Our results are very successfull. After SupraCor, the patients start to reading near vision in a few minutes. It can be for both of the eyes. It can give free life style for you. Designed for the full refractive treatment range and also potentially suitable for patients with previous LASIK surgery.
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Люди с миопией более 12 диоптрий, дальнозоркостью более 6D и люди с астигматизмом больше чем 6D в возрасте от 18 до 60 лет, не имеющих системных заболеваний (сахарный диабет, ревматизм и т.д) а так же не имеющих хронических заболеваний глаз могут воспользоваться данным методом.
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