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Chapter-05 Refractive Surgeries

BOOK TITLE: Clinical Ophthalmology: Medical and Surgical Approach

Author
1. Sinha Rajesh
2. Sachdev Ritika
3. Sharma Namrata
4. Titiyal Jeewan S
ISBN
9789350250044
DOI
10.5005/jp/books/11246_5
Edition
2/e
Publishing Year
2011
Pages
17
Author Affiliations
1. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, All India Institute of Medical Sciences, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Center for Ophthalmic Sciences, AIIMS, New Delhi, India, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, RP Center, New Delhi, India, AIIMS, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medial Sciences, New Delhi, India, Dr RP Center for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India, Dr RP Centre for Ophthalmic Sciences, All India Institut
2. All India Institute of Medical Sciences New Delhi, India, Centre for Sight, Eye Hospital, Safdarjung Enclave, New Delhi, India, Dr. RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, AIIMS, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Centre for Sight, B5/24, Safdarjung Enclave, New Delhi, India, Guru Nanak Eye Center, MAMC, New Delhi-2 (India), Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
3. All India Institute of Medical Sciences (AIIMS), New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
4. All India Institute of Medical Sciences, New Delhi India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, RP Center, New Delhi, India, RP Center for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India, AIIMS, New Delhi, India, Dr RP Center for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India, All India Institute of Medical Sciences, New Delhi, India
Chapter keywords

Abstract

Refractive surgery is one of the most evolved aspects of ophthalmic science and is undergoing rapid advancements each day in an endeavor to provide crystal clear vision without the aid of glasses and contact lenses. Patients with myopia, hyperopia and astigmatism can now reduce or eliminate their dependence on contact lenses and eyeglasses through refractive surgery that includes radial keratotomy (RK), photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), laser in-situ epithelial keratomileusis (LASEK), laser thermal keratoplasty (LTK), and intrastromal corneal rings (ICR). RK, PRK, LASIK, LASEK, LTK and ICR are the most common refractive surgeries presently performed in the United States in the treatment of patients with myopia, hyperopia and astigmatism. The object of these procedures is to change the refractive state of the eye by changing the shape of the cornea. There are two basic types of corrective refractive surgery. One changes the curvature of the cornea (outer surface of the eye). The other changes the internal optics of the eye, either by replacing the natural lens of the eye or by using an intraocular lens in addition to the natural lens. Three forms of refractive surgery are now commonly available in the U.S.: (i) RK as it is often called, is one of the oldest forms of refractive surgery. In RK, an eye surgeon usually uses a scalpel to make from four to eight tiny cuts into the cornea. The cuts are arranged like spokes on a wheel. The cuts allow the cornea to flatten, lessening its focusing effect on the light entering the eye. This process is most commonly used to correct nearsightedness. (ii) PRK, is a more recent development in refractive surgery. In PRK, however, a laser is used to remove the outer layers of the cornea to create a flatter shape. The laser instrument used in PRK can also re-shape the cornea to correct conditions like nearsightedness and astigmatism. (iii) LASIK is another type of refractive surgery that uses a laser to reshape the cornea. Rather than removing the outer layers of the cornea like PRK, a surgeon performing LASIK first uses a special cutting instrument to cut a thin flap into the top of the cornea. This outer flap is folded back and the exposed inner tissue of the cornea is then reshaped with the laser. Afterward, the flap is folded back into place. This preserves the outer layers of the cornea and helps to speed healing. Several other forms of refractive surgery are under development but are not yet widely available.

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