Eye Care
EpiLASIK is designed to restore natural vision with the help of an epikeratome. The doctor uses an epikeratome, a separator that creates an epithelial sheet, to make a thin flap in the epithelium. The Wavefront based excimer laser beam is then applied under the epithelial flap to successfully correct refractive errors and restore clear vision.
5. All Laser LASIK (with Femtosecond Laser)
All-Laser Lasik, also called "IntraLasik", is exactly like traditional conventional or custom wavefront Lasik, except the corneal flap is created with a femtosecond laser microkeratome rather than a mechanical microkeratome with a metal blade.
All-Laser Lasik may be performed with conventional laser ablation or wavefront-guided custom Lasik laser ablation.
There are several advantages to All-Laser Lasik that can make All-Laser Lasik more predictable and safer than traditional Lasik with a mechanical microkeratome, however there are limitations and a unique set of concerns that need to be evaluated.
Advantages include more precise positioning of the flap, more accurate thickness of the flap, more even thickness of the flap throughout, and a lower probability of intraoperative complications such as buttonhole flaps, thin/thick flaps, or epithelial defect. Recent studies have shown All-Laser Lasik to be more favorable than Lasik with a mechanical microkeratome in providing vision with better contrast sensitivity.
Some patients, but not all, experience a short period of increased corneal edema with All-Laser Lasik. This slight swelling can cause vision to be blurry, but the swelling normally resolves with healing. Occasionally an All-Laser Lasik patient will experience some photosensitivity. All these issues usually resolve during the normal Lasik six-month healing process, however additional eye drop medication may be required.
Conductive keratoplasty (CK) is a type of refractive surgery that uses mild heat from radio waves to shrink the glue-like connective tissue (collagen) in the edges of the cornea. This steepens the cornea, giving farsighted patients with presbyopia better near and distance vision while improving near vision for patients with presbyopia alone.
The main advantage of CK is that it is non-invasive. Unlike LASIK, CK does not involve knives or lasers cutting into ocular tissue, nor is any instrument inserted into the eye. Therefore, CK tends to cause fewer surgical complications than other refractive procedures.
CK is an outpatient procedure and takes about 15 minutes. It uses heat from radio frequency waves to shrink collagen and change the shape of the cornea. The surgeon uses a hand-piece containing a tiny, pen-shaped probe (Keratoplast Tip) that releases the frequency over the surrounding area of the cornea. The doctor will insert a few anesthetic eye drops into your eyes, then apply a special tool (speculum) between the eyelids to prop them open and prevent blinking.
In CK, the speculum also serves as a return path (that is, a ground) for the radio frequency produced by the probe. Using a rinse-away dye, the surgeon will imprint a treatment pattern on your cornea, showing where the radio frequency should be applied. Only a few seconds of the treatment are required for each eye.
CK is painless, although some patients say they feel a slight pressure on the eye. Both eyes can be done during the same visit (if you are being treated for hyperopia), so there is virtually no down time.
After CK
Your doctor will give you a prescription for eye drops that help prevent infection and reduce inflammation. Some may ask you to wear special bandage contact lenses for a few days to minimize discomfort. You can leave the doctor's office right after CK, although someone else must drive you home.
You may experience a foreign body sensation when the topical anesthetic wears off (about 20 to 30 minutes after the procedure), similar to the feeling of a piece of dirt or debris in your eye. Although you will be able to function normally, for the first week you may be slightly nearsighted. However, these side effects should clear up quickly. You also may find your eyes are sensitive to bright light. Wearing sunglasses for up to one week is sometimes necessary.
C. COSMETIC SURGERY OF THE EYELID
Pterygia are wedge- or wing-shaped growths of benign fibrous tissue with blood vessels, typically located on the surface tissue of the sclera. In extreme cases, pterygia may grow onto the eye's cornea and interfere with vision. Because a pterygium resembles tissue or film growing over the eye, a person who has one may become concerned about personal appearance. Prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia.
Many people with pterygia do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a feeling of having a foreign body in the eye. Large and advanced pterygia can actually cause a distortion of the surface of the cornea and induce an astigmatism.
Treatment depends on the pterygium's size and the symptoms caused by the pterygium. If a pterygium is small but becomes inflamed, your doctor may prescribe lubricants or possibly a mild steroid eye drop to reduce swelling and redness. In some cases, surgical removal of the pterygium is necessary.
The pterygia may be removed in an outpatient procedure room. For milder pterygia, a topical anesthetic can be applied prior to surgery to deaden feeling in your eye's surface. Your eyelids will be kept open with an eyelid speculum while the pterygium is surgically removed. After the procedure, which usually lasts no longer than 30 minutes, you likely will need to wear an eye patch for protection for a day or two. For uncomplicated surgery, you should be able to return to work or normal activities the next day.
Unfortunately, pterygia often return after surgical removal. In fact, the recurrence rate is between 3% and 40%. To prevent regrowth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, is very safe and has a low recurrence rate. A drug that slows metabolic processes contributing to tissue growth, such as mitomycin, may be applied topically. After removal of the pterygium, steroid eye drops may be used for several weeks to decrease swelling and prevent regrowth.
An ectropion is an outwardly turned eyelid. The lower eyelid is nearly always affected. In most cases, the cause is involutional and is associated with the aging process. Normal aging may cause laxity of the small muscle groups that hold the eyelid in place. When the eyelid muscles can no longer keep the lid taut against the eye, it sags, causing dryness and irritation. most surgeons elect to shorten and tighten the lower lid, thereby resolving the outwardly turned lid. This typically is completed with an incision of the skin at the lateral corner of the eye. The surgeon then excises a small segment of the lateral aspect of the lower eyelid, and subsequently reconnects the eyelid to underlying tissues and the upper eyelid. Usually only a few stitches are placed in the skin at the lateral corner of the eye, and these are often removed 7 to 14 days later. There is typically almost immediate resolution of the condition. Most patients have little if any discomfort with the procedure. There may be mild bruising and swelling following the procedure. This should resolve within two weeks.
Ectropion which occurs as a result of scarring (cicatricial ectropion) is most likely to follow another surgical procedure of the face or eyelids, especially excision of skin lesions such as skin cancers. This type of ectropion repair often requires skin grafting. The donor site for the skin graft is most often taken from the patient’s upper eyelid or from behind the ear. The skin from these sites will most closely match that of the patient’s lower eyelid skin. Both the donor site for the graft and the surgical site will usually heal nicely within two weeks following the surgery.
An entropion is an inwardly turned (inverted) eyelid. The condition occurs primarily as a result of advancing age with consequent weakening of certain eyelid muscles. The imbalance between eyelid muscle groups results in the inward turning of the eyelid. The condition almost always affects the lower, rather than the upper, eyelids. Repair of involutional entropion (associated with aging) may be completed with a variety of procedures. Most cases are completed with an incision in the lateral corner of the eye or an incision just beneath the lower eyelashes. In either case, a tightening of tissues is required to resolve the imbalance between the muscle groups of the lower lid.
Most patients experience immediate resolution of the problem once surgery is completed with little if any post-operative discomfort. Most cases will require subsequent removal of sutures located along the lower eyelashes or the lateral corner of the eyelid. Minor bruising or swelling may be expected and will likely resolve in one to two weeks following surgery.
A non-incisional entropion repair, known as a Quickert procedure, may be completed as an outpatient procedure. This form of entropion repair requires two or three strategically placed sutures which will evert the eyelid. The procedure can be completed under local anesthesia with little if any discomfort.
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