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Mastering the Techniques of Customized Lasik (Technology and Innovations)
Ashok Garg, Bojan Pajic, JT Lin, Jerome Jean Bovet
SECTION 1: BIOPHYSICS AND PRELIMINARY CONSIDERATIONS IN CUSTOMIZED LASIK
CHAPTER 1:
The Return the Corneal Surface: The Evolution of Excimer Laser Surgery
INTRODUCTION
FIRST ACT
The Change in Corneal Architecture to obtain a Refractive Result
Radial Keratotomy
Keratomileusis
SECOND ACT
The Excimer Laser as a Surface Approach
THIRD ACT
LASIK: The Magical Reshape Inside the Cornea
FOURTH ACT
Back to the Surface
CONCLUSIONS (EPILOGUE)
CHAPTER 2:
Biophysics Aspects Ophthalmic Lasers
INTRODUCTION
THE KEY ISSUES
LASER PRINCIPLES
LASER PARAMETERS
LIGHT-MATTER INTERACTION
LASER-TISSUE INTERACTION
COLD VS HOT LASERS
SELECTIVE INTERACTION
FREQUENCY CONVERSION (LIN, 1989)
Harmonic Generation (Fig. 2.8)
Raman Shift (SRS)
OPO
NONLINEAR PROCESSES (BOYD, 1992)
LASER PHACOEMULSIFICATION
CONCLUSION AND NEW DIRECTIONS
CHAPTER 3:
Clinical Aspects of Scanning Lasers in Customized LASIK
INTRODUCTION
ENGINEERING AND CLINICAL CORRELATION
TECHNOLOGY SUMMARY
LASIK PRINCIPLES
Single-zone Method
Multizone Method
High-order Formulas in LASIK
Aspherical Profile
MICROKERATOME TECHNOLOGY
LASIK SYSTEM
The Advantages of Scanning Laser
Optimal Scanning Parameters
Positive Cylinder Correction
Compound (toric) Error
WAVEFRONT TECHNOLOGY
Zernike Analysis for Different Devices
Shape Factor Analysis
CUSTOMIZED CORRECTION
Topography-guided LASIK
Limitations of CCR
CHAPTER 4:
Corneal Topographers and Wavefront Aberrometers—Clinical Applications
INTRODUCTION
KERATOMETERS
CORNEAL TOPOGRAPHY
ELEVATION-BASED TOPOGRAPHY
WAVEFRONT: ANOTHER VIEW OF CORNEAL OPTICS
CASES
Case I: Double Vision Complaints S/P LASIK
Case II: Night Vision Complaints S/P LASIK
Case III: Complaint of Multiple Images after Hyperopic LASIK
Case IV: Double Vision with Loss of Best Correction S/P LASIK
Case V: Hyperopic Keratorefractive Surgery Results in Steep Cornea
CONCLUSION
CHAPTER 5:
The Orbscan IIz Diagnostic System and Zywave Analysis
INTRODUCTION
ORBSCAN
QUAD MAP
POWER MAPS
PACHYMETRY MAP
READING CORNEAL ELEVATION MAPS
Global Perspective
POSTERIOR CORNEAL ELEVATION MAPS
THREE STEP RULE
PREOPERATIVE LASIK SCREENING
Three Step Rule
MIDDLE BOX
ORBSCAN RISK OF ECTASIA INDICES
CLINICAL EXAMPLES
ZYOPTIX
ACKNOWLEDGEMENT
CHAPTER 6:
Nidek OPD Scan in Clinical Practice
INTRODUCTION
NIDEK OPD SCAN
Guide to Clinical Interpretation with the Nidek OPD Scan
Nidek OPD Scan Six Map Display
Summary
CLINICAL EXAMPLES
Normal Bowtie Astigmatism (Fig. 6.3)
Keratoconus (Fig. 6.4)
Pellucid Marginal Degeneration (Fig. 6.5)
Decentered LASIK Ablation (Fig. 6.6)
CONCLUSION
CHAPTER 7:
Orbscan Corneal Topography in Refractive Surgery
INTRODUCTION
ORBSCAN CORNEAL MAPPING FOR REFRACTIVE SURGERY DIAGNOSTICS
SELECTION CRITERIA
POWER MAPS
POSTERIOR ELEVATION
PACHYMETRY
COMPOSITE/INTEGRATED INFORMATION
CHAPTER 8:
Mathematical Handbook of LASIK
INTRODUCTION
REFRACTION POWER
REFRACTIVE ERROR (D)
LASIK ABLATION RATE
BIFOCAL (PRESBY-LASIK)
ASPHERICITY COMPARISON
MIXED ASTIGMATISM
LASIK ABLATION NOMOGRAM
Spherical Surface
Aspherical Surface
Asphericity Control
SURFACE ABERRATION
CONCLUSION
CHAPTER 9:
Online Optical Coherence Pachymetry (OCP)
INTRODUCTION
ONLINE OCP INCREASES SAFETY DURING LASIK
VARIOUS WAYS OF MEASURING CORNEAL THICKNESS
DISCUSSION
OCP Versus Ultrasound Pachymetry
Advantages of OCP
CONCLUSIONS
Take-Home Message
SECTION 2: VARIOUS COUSTOMIZED LASIK TECHNIQUES AND PLATFORMS
CHAPTER 10:
Update of Customized Corneal Reshaping for Supervision
INTRODUCTION
SPHERICAL ABLATION
First-order Formulas
High-order Formulas
ASPHERICAL ABLATION
Optimized Transition Zone (OTZ)
Corneal Asphericity Change
Q-Factor Customized Ablation
SHAPE FACTOR ANALYSIS
POSITIVE CYLINDER FOR MIXED ASTIGMATISM
CUSTOMIZED CORRECTION
Topography-guided LASIK
NEW DIRECTIONS
CONCLUSION
CHAPTER 11:
Pearls of Rotational Eye Tracker System in Lasik Outcomes
INTRODUCTION
DESCRIPTION OF THE IMPLEMENTED IRIS RECOGNITION TECHNOLOGY
Clinical Evidence for the need of Rotational Tracking
Published Literature
Own Datas of Cyclotorsional Measurements with B&L's Rotational Tracker
Technical Background of B&L's H.EYE.TECH Iris Pattern Recognition
Design of the Iris Pattern Recognition Tool
IMPLEMENTATION INTO THE PLATFORM
Therapeutic Module (H.EYE.TECH)
General Functionality of the Eyetracker System
Lateral Eyetracker System
Rotational Eyetracker System
ACKNOWLEDGMENTS
CHAPTER 12:
Customized Excimer Laser Treatment using the Wavelight Allegretto Eye Q Laser
WHAT IS CUSTOMIZED EXCIMER LASER TREATMENT?
THE LASER
TREATMENT PRINCIPLES
Corneal Asphericity
REQUIREMENTS FOR CUSTOM ABLATION
Optokinetic Eyetracking to Compensate for Cyclotorsion and Decentration
Improper Head Alignment
Movement from Sitting to Supine Position can Cause Cyclotorsion
Saccadic Eye Movements
Pupil Shift
Eye Rolling
Technical Misalignment of Laser Beam
THE DIFFERENCE BETWEEN WAVEFRONT GUIDED AND TOPOGRAPHY GUIDED CUSTOM ABLATION
Wavefront Data
Topography Data
INDICATIONS FOR CUSTOM ABLATION
General Indications
Indications for the Standard or Wavefront Optimized [WFO] Treatment
Indications for Custom Q Treatment [F-CAT]
Indications for T-CAT
T-CAT following Previous PKP
T-CAT after Previous RK
Indications for Oculink Ablation Based on the Oculyzer
Indications for A-CAT
OBTAINING MAPS FOR CUSTOM ABLATION TREATMENT
Measuring Technique
Different Types
Topolyzer Maps
Oculyzer Map
TREATMENT PROGRAMS
Standard Treatment Program
Custom Q Program [F-CAT]
T-CAT Treatment
T-CAT after Previous Penetrating Keratoplasty [PKP]
T-CAT After Previous RK
T-CAT for Other Indications
Oculink Treatment Program
A-CAT [Wavefront Analyzer guided Custom Ablation Treatment
RESULTS
Results of Wavefront Optimized [or Standard] Treatment
Results of Custom Q Treatment [F-CAT]
Results of Wavefront Guided Treatment [A-CAT]
T-CAT Results
COMPLICATIONS OF CUSTOMIZED ABLATION
General Complications
Complications of Standard [WFO] Ablation
Complications of Custom Q Ablation
Complications of A-CAT
Complications of T-CAT
LASIK VS ADVANCED SURFACE ABLATION COMBINED WITH CUSTOMIZED ABLATION
Lasik with Custom Ablation
Advanced Surface Ablation [ASA] with Custom Ablation
CHAPTER 13:
Optimizing Astigmatic Parameters in Lasik Treatments using Vector Planning
INTRODUCTION
LIMITATIONS OF WAVEFRONT- OR TOPOGRAPHIC-GUIDED TREATMENTS ALONE
REFRACTIVE VERSUS CORNEAL ASTIGMATISM
Calculation of ORA
COMBINING WAVEFRONT AND TOPOGRAPHIC DATA USING VECTOR PLANNING
Outcomes Using Combined Topographic and Refractive Parameters to Optimally Treat Astigmatism
Vector Planning—A Case Study
SUMMARY
CHAPTER 14:
Wavefront LASIK
INTRODUCTION
ADVANTAGES OF WAVEFRONT GUIDED LASIK
LIMITATIONS OF WAVEFRONT GUIDED LASIK
Laser Factors
Biomechanical Issues
Role of the Pupil
The Optical Zone
Corneal Wound Healing
Decentration
Tear Film
CONCLUSIONS
CHAPTER 15:
PENTACAM Technology in Customized Refractive Surgery
INTRODUCTION
CORNEOPLASTIQUE™ AND PENTACAM
THE FUTURE FOR PENTACAM
CHAPTER 16:
NAV Wave: Customized Ablation with Nidek Platform
INTRODUCTION
OPD-SCAN
Topography and Wavefront Analyzer
OPD Power Map
OPD Power Map and Wavefront Map
OPD Map and Cornea Topography Map
Aligning Topography Data with OPD Data
Measurement of Pupillary Diameter
Final Fit Software: Outline and Features
Customized Ablation
Spherical with OATZ Ablation
Topo-guided Customized Ablation
Wavefront-guided Customized Ablation
Features of the Final Fit Software
Correction of Cyclo-Torsion
CHAPTER 17:
Wavefront and Topography Guided Lasik
INTRODUCTION
ABERRATIONS
ZYOPTIX LASER
ORBSCAN
ABERROMETER
ZYLINK
RESULTS
DISCUSSION
CONCLUSION
CHAPTER 18:
Customized Topographic Repair with the New Platform: Zeiss Mel80/ New CRS Master Tosca II
INTRODUCTION
WAVEFRONT GUIDED VS TOPOGRAPHY GUIDED
Technique
What does the literature learns us concerning the treatment approach?
Laser Technology Requirements for Customized Corneal Ablation
INDICATIONS FOR CUSTOMIZED TOPOGRAPHY-GUIDED LASER
PERSONAL APPROACH
Software
SURGEONS CAN GO BETWEEN PLATFORMS
TOPOGRAPHY-GUIDED VS WAVEFRONT USING THE CRS MASTER
Iris Capture-Oculign
Available Treatments Increased
PERSONAL RESULTS
CONCLUSIONS
CHAPTER 19:
Customized LASIK Treatment for Myopia: An Indepth Assessment
INTRODUCTION
LASIK FOR LOW TO MODERATE MYOPIA
LASIK IN HIGH MYOPIA
Strategies for a LASIK in High Myopia
Decreasing the Optical Zone
Application of an Aspheric Profile
Reducing the Thickness of the Corneal Flap
Managing Myopia in Conjunction with Simple Compound and Mixed Astigmatic Errors
Strategy to Optimize Cornea—Laser Coordination
Customized LASIK for Myopia
BASIC REQUIREMENTS FOR ACCURATE TOPOGRAPHY GUIDED ABLATION
REQUISITES FOR A GOOD WAVEFRONT MEASUREMENT
RESULTS OF WAVEFRONT GUIDED LASIK IN MYOPIA
CHAPTER 20:
Zyoptix Laser
INTRODUCTION
ABERRATIONS
ZYOPTIX LASER
ORBSCAN
ABERROMETER
ZYLINK
RESULTS
DISCUSSION
CONCLUSION
CHAPTER 21:
Wavefront Analysis and Wavefront Treatment in LASIK Eyes
INTRODUCTION
PATIENTS AND METHODS
Wavefront Aberrometry
RESULTS
Confocal Microscopy Analysis
DISCUSSION
ACKNOWLEDGMENTS
CHAPTER 22:
Wavefront Optimize Lasik
INTRODUCTION
NORMAL CORNEAL SHAPE AND ASPHERICITY
SPHERICAL ABERRATION (FIG. 22.8)
WAVEFRONT OPTIMIZED TECHNOLOGY (FIG. 22.9)
CLINICAL IMPLICATIONS
CONCLUSION (FIG. 22.11)
CHAPTER 23:
Wavefront Guided LASIK after Penetrating Keratoplasty
INTRODUCTION
TIMING OF LASIK AFTER KERATOPLASTY
TECHNIQUE
CASE STUDY
CONCLUSION
CHAPTER 24:
Corneal Wavefront Guided LASIK for Corblyopia
INTRODUCTION
A Short Historical Account of Topography
TOPOGRAPHY AND WAVEFRONTS
A Few Basics
The Concept of the Corneal Wavefront
Methods
Advantages of ORK CORWAVE (ORK-W)
The Keratron Scout
STEPS in Performing a Corneal Wavefront Guided Ablation
ANISOMETROPIC AMBLYOPIA IN CHILDREN
CORBLYOPIA: A NEW ENTITY
CONCLUSION
CHAPTER 25:
Strategic Planning in Topography-guided Ablation of Aberrated Eyes and Evaluation After Laser Refractive Surgery
INTRODUCTION
THE TOOLS OF THE TRADE
LASIK AFTER PENETRATING KERATOPLASTY
GENERAL SURGICAL TECHNIQUE
GRAFT ENDOTHELIAL INTEGRITY
LASIK AFTER OCULAR TRAUMA
LASIK AFTER RADIAL OR ARCUATE KERATOTOMY
CHAPTER 26:
Topography-guided Ablation with Allegretto Wave Eye Q Excimer Laser: T-CAT
INTRODUCTION
ALLEGRO TOPOLYZER
Overview Display
3D Image Display
Fourier Analysis
Fourier Indices
Application of Fourier Display Mode in Keratoconus
Zernike Analysis
Zernike: Normal Values and Aberration Coefficient
Indices
Pupillometric Analysis
HOW TO PERFORM T-CAT?
CHAPTER 27:
Pharmacotherapeutics in LASIK Surgery
INTRODUCTION
PREPROCEDURE THERAPEUTIC MEDICATIONS
Topical Anesthesia
POSTPROCEDURE THERAPEUTIC MEDICATIONS
PHASES OF HEALING
CHAPTER 28:
Customized LASIK
INTRODUCTION
WAVEFRONT TECHNOLOGY AND LASIK
FORMS OF CUSTOMIZATION
WAVEFRONT ABERRATIONS: MEASUREMENT AND LASER INTERFACE
TECHNOLOGY ADVANCEMENTS
Physical Properties of the Laser
Eye Tracking
POSTOPERATIVE OUTCOMES WITH CUSTOMIZED LASIK
RECENT FINDINGS
SUMMARY
CHAPTER 29:
Customized and Advanced LASIK with Aspheric Ablation Profile
ADVANCED EXCIMER LASER PLATFORM COMPONENTS
ALIGNMENT STRATEGIES
CLINICAL APPLICATION (OATZ, CATZ AND OPDCAT)
RETREATMENTS IN SYMPTOMATIC EYES
CASE EXAMPLE
SUMMARY
SECTION 3: CUSTOMIZED LASIK COMPLICATIONS AND MANAGEMENT
CHAPTER 30:
Pitfalls in Customized LASIK: How to Avoid them?
INTRODUCTION
PREOPERATIVE CONSIDERATIONS
Unstable Refractive Error
Cataract Development
Corneal Thickness
Systemic Disease
Large Pupils
Ocular Disease
Preoperative Keratometry Readings
Preoperative Corneal Topographical Mapping
Unrealistic Expectations
High Refractive Error
PREOPERATIVE EVALUATION
Pachymetry (Corneal Thickness Measurement)
Pupil Diameter
Topography
Keratometry
Manifest/Cycloplegic Refraction
Cover Test
Tear Film Assessment
Slit Lamp Examination (Anterior Segment Evaluation)
Dilated Fundus Examination
FOLLOW-UP VISITS FOR CO-MANAGEMENT OF REFRACTIVE SURGERY PATIENTS
POTENTIAL POSTOPERATIVE SIGNS/SYMPTOMS AND THEIR MANAGEMENT FOR LASIK PATIENT
Sign/Symptom
Management
POSSIBLE COMPLICATIONS OF LASIK
Intraoperative Complications
Early Postoperative Complications
Late Postoperative Complications
Monitoring IOP
Check List Preoperative
Check List Intraoperative
Check List Postoperative
CRITERIA FOR RETREATMENT FOLLOWING LASIK
Conditions Recommended for Retreatment
CHAPTER 31:
Post LASIK Corneal Ectasia: The Orbscan Analysis
INTRODUCTION
CORNEAL ECTASIA
SELECTION CRITERIA
PACHYMETRY5
POSTERIOR ELEVATION MAP (FIG. 31.4)
POWER MAP
COMPOSITE/INTEGRATED INFORMATION
FUTURE THOUGHTS
ACKNOWLEDGEMENTS
CHAPTER 32:
Update on Management of LASIK Complications
INTRODUCTION
MICROKERATOME COMPLICATIONS
Free Cap
Incomplete Flap
Thin Flaps, Button-holes and Irregular Cuts
Epithelial Defects
Corneal Bleeding
Corneal Perforation
LASER COMPLICATIONS
Decentered Ablation
Central Islands
POSTOPERATIVE COMPLICATIONS
Flap Folds and Wrinkles
Flap Loss
Interface Debris
Sands of the Sahara Syndrome
Epithelial Ingrowth
Infection
Dry Eye
Regression, Undercorrection and Overcorrection
Corneal Ectasia
Retinal Complications
CHAPTER 33:
Vital Issues Affecting LASIK Procedure Outcomes
INTRODUCTION
LASER SYSTEM AND PARAMETERS
MICROKERATOME
ABLATION ALGORITHMS
High-order Term
Aberration Rate Calibration
Optimized Transition Zone (OTZ)
Corneal Asphericity Change
Q-factor Customized Ablation
CONCLUSIONS
CHAPTER 34:
Management of Post Lasik Diffused Lamellar Keratitis
DISEASE ENTITY
CLINICAL FEATURES
Corneal
Ocular
PATHOGENESIS
DIAGNOSIS
CLASSIFICATION
Hatsis Classification of “Sands of Sahara Syndrome” (Figs 34.6 to 34.9)4
Grade I (Fig. 34.6)
Grade II (Fig. 34.7)
Grade III (Fig. 34.8)
Grade IV (Fig. 34.10)
ETIOLOGY
Toxic Insult
Traumatic Insult
Thermal Insult
DIFFERENTIAL DIAGNOSIS
Delayed Onset
Late Onset or Secondary
Pseudosands
MANAGEMENT—PREVENTION
Clean Equipment
Endotoxin
Powderless Gloves
Thermal Damage
Reduce Epithelial Abrasion
MANAGEMENT—TREATMENT
Grade I
Grade II
Grade III
Grade IV
CONCLUSIONS
CHAPTER 35:
A Refined Algorithm for Controlling Post Operative Corneal Asphericity in Lasik
INTRODUCTION
ASPHERICA PROFILE
COMPARING WITH MEASUREMENTS
PREDICTION OF CORNEAL ASPHERICITY
Example # 1
Example # 2
CENTRAL ABLATION DEPTH
EFFECTIVE ZONE SIZE
SURFACE ABERRATION
APPLICATIONS
Application # 1
Application # 2
Application # 3
Application # 4
DISCUSSIONS
CONCLUSIONS
APPENDIX
The Lin's N = 2/3 Power Factor
CHAPTER 36:
Dry Eye Management after Lasik Surgery
INTRODUCTION
COMPLICATIONS IN REFRACTIVE SURGERY
THE TEAR FILM
THE “DRY EYE” OR THE OCULAR SURFACE SYNDROME (OSS)
THE OCULAR SURFACE SYNDROME (OSS)
BASIC SCIENCES IN OSS
Corneal Innervation and the Ocular Surface Syndrome (OSS)
Surface Properties of the Normal and the Damaged Corneal Epithelium
Pre-surgical Examinations for Determination of Eventual OSS Problems in the Prospective Refractive Surgery Patient
Patient History
Ocular Examination for OSS
Ocular Examination for Blepharitis
Tear Stability Tests
Invasive Tear Breakup Time (TBUT, Fluorescein Break Up Time)
Non-invasive Tests of Tear Film Stability
Tear Volume Tests
Invasive Tests
Non-invasive Tests
Other Tests
Impression Cytology
Corneal Topography in Combination with Confocal Biomicroscopy
MANAGEMENT OF THE OCULAR SURFACE SYNDROME
Blepharitis
Frequency and Composition of Evaluation and Management Visits for OSS
Mild Induced OSS
Moderate OSS
Severe OSS
In More Detail
Artificial Tears
Oral Antioxidants
Punctal Occlusion
Other Treatment Alternatives
CHAPTER 37:
Post Lasik Dry Eye and Lasik Hinge Location
INTRODUCTION
CONCLUSIONS
SECTION 4: RECENT ADVANCES IN CUSTOMIZED LASIK TECHNIQUES
CHAPTER 38:
Customized Flap Cutting with Femtosecond Laser
INTRODUCTION
METHODS AND PATIENTS
CONFOCAL CORNEAL LASER-MICROSCOPY
LASER-SCANNING MICROSCOPY AND PACHYMETRY
RESULTS
DISCUSSION
CHAPTER 39:
The Custom Refractive and Custom Therapeutic Surgical Platform
INTRODUCTION
THE DIAGNOSTIC PRODUCTS
Precisio—High Definition Corneal Tomography
The Technology
Diagnostic and Surgical Modes
The Clinical Applications
pMetrics—Binocular, Dynamic Pupil Assessment
The Technology
The Ideal Pupil
THE DESIGN PRODUCTS
CIPTA – Corneal Interactive Programmed Topographic Ablation
The Technology
Morphologic Axis vs Optic Axis
cTEN™ (Custom Transepithelial “all laser, no touch” Treatment Strategy)
Variable Width Constant Slope Transition Zone (Fig. 39.6)
Corneal Lamellar Ablation for Transplantation (CLAT)
The Surgical Process
iRES - High Resolution, Ultra-fast Custom Refractive and Custom Therapeutic Laser
The Technology
Constant Frequency per Area™ (Fig. 39.9)
Clinical Applications
CHAPTER 40:
Customized LASIK: Aspherical Treatments with ESIRIS Schwind Platform
THEORETICAL BACKGROUND
Introduction
Aspherical Treatments with the ESIRIS Schwind Platform
Classical Approaches for Spherocylindrical Correction
Example Correction of Asphericity Based Myopia
Key Factors in the ORK-CAM Profiles
Different Ablation Ratios for PRK/Lasek or LASIK Treatments
Multi-Dynamic Transition zone
Meaning of the “3+ Aspherical Dimensions” in the ORK-CAM Profiles
Enhanced Energy Correction to Compensate the Loss of Ablation Efficiency
CLINICAL RESULTS
Introduction
Aspherical ORK-CAM Treatments in Patients with Myopia or Myopic Astigmatism
Aspherical ORK-CAM Treatments in Patients with Hyperopia or Hyperopic Astigmatism
CONCLUSIONS
CHAPTER 41:
Comparison of Wavefront Guided vs Wavefront Optimizing LASIK Procedure with Allegretto Wavelight Laser
INTRODUCTION
OLD SCIENCE, NEW APPLICATION
Simple Wavefronts and Propagation
Wavefront aberrations (Fig. 41.4)
Zernike Polynomials (Figs 41.6 and 41.7)
WAVEFRONT SENSOR AND RECONSTRUCTION TECHNIQUES (FIG. 41.8)
Hartmann-Shack Principle
Tscherning Principle (Fig. 41.10)
WAVEFRONT DIAGNOSIS AND WAVEFRONT TREATMENT (FIG. 41.11)
Several Laser Options8
Higher Order Aberrations
Positional Considerations8–10
Ablate Deeper
Monovision Limitations
Wavefront Diagnostic For Every Patient
CLINICAL STUDIES13
CONCLUSIONS
CHAPTER 42:
Aspheric Ablation with Nidek Platform
INTRODUCTION
THE NIDEK ADVANCED VISION EXCIMER LASER SYSTEM (NAVEX)
The OPD Scan (Fig. 42.1)
The OPD Software
The Final Fit
The NAVEX
The Ablation Profiles
CHAPTER 43:
Recent Advances in LASIK Techniques
FEMTOSECOND LASER
PATTERN OF ELEVATED, IRREGULAR ASTIGMATISM AND ABERRATION HIGHER ORDER AFTER PERFORMING A LAMELLAR KERATOTOMY WITH AN AMADEUS SIS KERATOM IN KERATOPLASTY EYES
Aim
Patients and Methods
Results
Conclusion
ROTATIONAL EYETRACKER SYSTEM
ASPHERIC ABLATION ALGORITHMS
WAVEFRONT DRIVEN PROCEDURES WITHOUT PHARMACOLOGICAL PUPIL DILATION
OPTICAL COHERENCE TOMOGRAPHY—INTEGRATED ONLINE PACHYMETRY (OCP)
CONCLUSIONS
Acknowledgments
CHAPTER 44:
Pearls of Aberrometric Correction of Presbyopia: An Evidence Based Update
PRESBYOPIA AND ACCOMODATION
Spherical Aberration
THE EYE AND THE SPHERICAL ABERRATION
Risultati
Fifty-seven-year Old Emmetropic Patient (Figs 44.20 and 44.21)
CHAPTER 45:
Bifocal Corneal Reshaping for Presbyopia
INTRODUCTION
TWO-STEP STRATEGY
COMPARISON OF ABLATION PROFILES
CENTRAL ABLATION DEPTHS
BIFOCAL PROFILES (CM & PM)
DISCUSSION
CONCLUSIONS
APPENDIX
CHAPTER 46:
Zyoptix Aspheric
INTRODUCTION
ASPHERICITY
SPHERICAL ABERRATION
Etiology of Postoperative Spherical Aberration
Fluence Modeling
The Biomechanical Effect of Laser Ablation
Increased Peripheral Reflectance
Other Factors
Aspheric LASIK
Factors For Spherical Aberration
Pupillary Size
Refractive Change
Aspheric LASIK- Design Goal
Measurement of Q-Value
Aspheric Ablation Pattern Design
CLINICAL RECOMMENDATIONS AND PATIENT SELECTION
Candidates Ideal For Aspheric LASIK
Candidates for Tissue Saving Aspheric Mode
Candidates for Personalized (Wavefront Guided) Treatment
CONCLUSIONS
Acknowledgement
CHAPTER 47:
Customized LASIK for Presbyopia: PML™ (Presbyopic Multifocal LASIK) Technique
WHY “CUSTOMIZATION” IN THE LASIK TREATMENT FOR PRESBYOPIA
THE CORRECTION OF PRESBYOPIA
APPROACHES TO THE SURGICAL CORRECTION OF PRESBYOPIA
THE PML™ PROCEDURE
CLINICAL CASES: EXAMPLES OF CUSTOMIZED PRESBYOPIC TREATMENT WITH PML™
Case Example A: Emmetropic-Presbyope (Figs 47.7 and 47.8)
Clinical History
Case Example B: Hyperopic-Presbyope (Figs 47.9 and 47.10)
Case Example C: Myopic-presbyope (Figs 47.11 and 47.12)
Case Example D: Mixed Astigmatic-Presbyope (Figs 47.13 and 47.14)
Short Comments of the Author to the Four Cases
Final Considerations
CHAPTER 48:
Advanced Custom Ablation: New Technology for Better Quality of Vision
INTRODUCTION
FACTORS TO BE CONSIDERED FOR CUSTOMIZED ABLATION
Age as a Criteria
Size of the LASIK Flap
Factors to be Considered for Customized Correction
CUSTOMIZATION BASED ON CORNEAL TOPOGRAPHY
Customization based on Wavefront Measurements
Advantages of Optical Wavefront Guided Lasik using the Hartman Shack Aberrometer
COMBINING OCULAR AND CORNEAL WAVE FRONT ABLATIONS
CHAPTER 49:
Customized Bifocal Lasik for Presbyopic Eyes
INTRODUCTION
TWO-STEP ABLATION
CENTRAL ABLATION DEPTHS
PREDICTION OF ASPHERICITY
BIFOCAL (PRESBY-LASIK)
COMPARING CM AND PM
Asphericity Comparison
CONCLUSIONS
CHAPTER 50:
Customized Aspherical Ablation for Minimum Aberration
INTRODUCTION
ASPHERICA PROFILE
PREDICTION OF CORNEAL ASPHERICITY
Example # 1
Example # 2
CENTRAL ABLATION DEPTH
POSITIVE CYLINDER FOR MIXED ASTIGMATISM
EFFECTIVE ZONE SIZE
SURFACE ABERRATION
APPLICATIONS
Application # 1
Application # 2
Application # 3
COMPARISON OF CENTRAL ABLATION DEPTHS
COMPARISON OF THEORY AND MEASUREMENTS
CONCLUSIONS
CHAPTER 51:
Customized Presby LASIK
INTRODUCTION
PATIENTS AND METHODS
RESULTS
DISCUSSION
CONCLUSIONS
CHAPTER 52:
Recent Advances in Customized LASIK
INTRODUCTION
ADVANCES IN NIDEK LASIK SYSTEM
OPD SCAN
Axial Map
Elevation Maps
CORNEAL NAVIGATOR
FINAL FIT SOFTWARE
OATZ
CATZ (Customized Aspheric Treatment Zone)
OPD-CAT (OPD or Wave front Guided Customized Aspheric Treatment)
OPA
ALIGNMENT IN CUSTOMIZED LASIK USING NAVEX PLATFORM
CONCLUSIONS
CHAPTER 53:
Advances in Refractive Surgery: Surface Ablation and LASIK
INTRODUCTION
FACTORS THAT FAVOR THE CHOICE OF LASIK AND EPI-LASIK
Two Factors almost always favor the Choice of LASIK
Safety Favors the Epi-lasik Procedure in Steeper Eyes
NEWER DESIGN EPI-KERATOMES WORK BETTER ON STEEP CORNEAS
CHAPTER 54:
Solid State Lasers for Refractive Surgery
BASIC LASER BACKGROUND
Light Amplification by Stimulated Emission of Radiation
Laser Pumps
Laser Media
Common Properties of Lasers
EXCIMER LASER
Basic Concepts
Disadvantages of Excimer Laser
High Voltage Requirement
Early Replacement of Special Switch
Corrosiveness and Toxicity of Fluorine Gas
Recurrent Expenses of Excimer Gases
High Cost for Proper Storage of Toxic Gases and Training of a Technician
Hydration Dependence of 193 nm
Other Disadvantages of Excimer Laser
SOLID STATE LASERS IN REFRACTIVE SURGERY
SOLID STATE LASER
History
Present Situation
Future of Solid State Laser
Technical Advantages of Solid State Laser
Solid State Technology
Advantages of Solid State Laser
213 nm Wavelength
Benefits of the 213 nm Wavelength
Tissue Hydration Study
Clinical Advantage
HISTOPATHOLOGICAL COMPARISON OF PHOTOREFRACTIVE KERATECTOMY (PRK) IN RABBITS WITH 193 NM AND 213 NM
Introduction
Methods
Analysis
Discussion
SCIENTIFIC BENEFITS
0.6 mm Flying Gaussian Beam Spot
CRYSTALSCAN
CORNEAL HYDRATION DURING ABLATION
NOMOGRAM ADJUSTMENT
ANYTIME SURGERY – FREEDOM TO DO SURGERIES AT YOUR CONVENIENCE
LESS MAINTENANCE AND COST
THE BOTTOM LINE
CHAPTER 55:
Future of LASIK Surgery
INTRODUCTION
ADVANCED TECHNOLOGIES
SURFACE TREATMENT VS LASIK
LENTICULAR REFRACTIVE SURGERY
CHAPTER 56:
CustomVis Solid State Laser
INTRODUCTION
THE PULZAR Z1 SOLID STATE LASER
Advantages of PULZAR Z1, Solid State Laser
213 nm Wavelength
Benefits of the 213 nm Wavelength
Clinical Advantage of 213 nm Over 193 nm for Nomogram Adjustment
HISTOPATHOLOGICAL COMPARISON OF PHOTOREFRACTIVE KERATECTOMY (PRK) IN RABBITS WITH 193 NM AND 213 NM
SCIENTIFIC BENEFITS
CORNEAL ABLATION WITH 213 NM
OTHER ADVANTAGES OF PULZAR Z1
SPECIAL FEATURES AVAILABLE TO THE PULZAR Z1
Eye Tracking
ZTRAK
GAZE TRACKING
Unique Advantages of Limbus EyeTracking (PULZAR Z1 Tracking System)
Pupil Tracking Problems in any Conventional Excimer Laser
CYCLOROTATION
0.6 MM FLYING GAUSSIAN BEAM SPOT
CRYSTALSCAN
HINGE PROTECTION
Advantages of Hinge Protection
AUTO-CENTRATION
AUTO-CALIBRATION
Advantages of Auto-calibration
FREEDOM TO SELECT TREATMENT CENTER
SAFETY FEATURES
Foot Switch
Laser Enable Button
Emergency Stop Button
TREATMENT PLANNING
STANDARD TREATMENTS
STANDARD TREATMENT FEATURES IN PULZAR Z1
Maintenance of Preoperative Corneal Asphericity
Saving Entered Treatments
Resuming an Aborted Ablation Process
CUSTOMIZED TREATMENTS
Special Features of ZCAD
Freedom of Choice of Optical Zone and Treatment Zone
Refraction Adjustments – Surgeon's Choice
Automatic Cylinder Notation Conversion
Corneal Asphericity Customization
Depth Offset
CT Scale
TRACEY WAVEFRONT ANALYZER
Data Displays
Other Advantages of Tracey
Tracy and CustomVis PULZAR Z1
CLINICAL OUTCOMES
Latest Clinical Results
Mild-to-Moderate Myopia
THE BOTTOM LINE
CHAPTER 57:
Wavefront Guided Correction of the Irregular Cornea
INTRODUCTION TO WAVEFRONT ABERRATION
CORNEAL WAVEFRONT ABERRATIONS
CORNEAL WAVEFRONT AS A GUIDE FOR THE CORRECTION OF IRREGULAR ASTIGMATISM
Basis of Treatment
Clinical Examination
Surgical Technique
Results
Efficacy
Safety
Predictability
Higher Order Aberrations
Total Higher Order Corneal Wavefront
First Order Aberrations
Coma-like Aberrations
Spherical-like Aberration
CASE REPORT
CONCLUSIONS
CHAPTER 58:
CustomVue™ Treatment with the VISX STAR S4 Excimer Laser System
THE VISX WAVESCAN WAVEFRONT SENSING DEVICE
Zernike Limitations
Why VISX Switched to Fourier
Newer Advances in VISX Technology
CustomVue™ Versus Conventional LASIK in Low to Moderate Myopia
CustomVuetm Treatment Versus Conventional Lasik In Hyperopia and Astigmatism
CustomVuetm Treatment In Presbyopia
Points for thought
INDEX
TOC
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