Surgical treatments

this is the surgery description

Cataract Surgery

IOL exchange

IOL exchange

ICCE

ICCE

ECCE

ECCE

Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract, causing impairment or loss of vision. Well over 90% of operations are successful in restoring useful vision, with a low complication rate. Day care, high volume, minimally invasive, small incision phacoemulsification with quick post-op recovery has become the standard of care in cataract surgery all over the world. Two main types of surgical procedures are in common use throughout the world. The first procedure is phacoemulsification (phaco) and the second involves two different types of extracapsular cataract extraction (ECCE). ECCE utilises a larger incision (10-12mm) and therefore usually requires stitching, and this in part led to the modification of ECCE known as manual small incision cataract surgery (MSICS). There are a number of different surgical techniques used in cataract surgery. Extracapsular cataract extraction (ECCE): Extracapsular cataract extraction involves the removal of almost the entire natural lens while the elastic lens capsule (posterior capsule) is left intact to allow implantation of an intraocular lens. It involves manual expression of the lens through a large (usually 10–12 mm) incision made in the cornea or sclera. Although it requires a larger incision and the use of stitches, the conventional method may be indicated for patients with very hard cataracts or other situations in which phacoemulsification is problematic.

Phacoemulsification

Phacoemulsification

Phacoemulsification (phaco) is the most common technique used in developed countries. It involves the use of a machine with an ultrasonic handpiece equipped with a titanium or steel tip. The tip vibrates at ultrasonic frequency (40,000 Hz) and the lens material is emulsified. A second fine instrument (sometimes called a "cracker" or "chopper") may be used from a side port to facilitate cracking or chopping of the nucleus into smaller pieces. Fragmentation into smaller pieces makes emulsification easier, as well as the aspiration of cortical material (soft part of the lens around the nucleus). After phacoemulsification of the lens nucleus and cortical material is completed, a dual irrigation-aspiration (I-A) probe or a bimanual I-A system is used to aspirate out the remaining peripheral cortical material. In most surgeries, an intraocular lens is inserted. Foldable lenses are generally used for the 2-3mm phaco incision, while non-foldable lenses are placed through the larger extracapsular incision. The small incision size used in phacoemulsification (2-3mm) often allows "sutureless" incision closure.

Corneal

Corneal pigmentation

Corneal pigmentation

Corneal pigmentation(also referred to as a eye tattoo) is the practice of tattooing the cornea of the human eye. Reasons for this practice include improvement of cosmetic appearance and the improvement of sight. Many different methods and procedures exist today, and there are varying opinions concerning the safety or success of this practice. Causes or reasons for corneal tattooing vary from patient to patient. Most patients receive treatment to alter the cosmetic appearance of their eyes following disease or accident. Others receive treatment for optical purposes, including decreasing circumstantial glare within the iris. Corneal opacities are the leading reason for undergoing cosmetic tattooing. Occasionally, corneal tattooing is performed when it might improve eyesight. According to Dr. Samuel Lewis Ziegler, indications for treatment include albinismaniridiacolobomairidodialysiskeratoconus, or diffused nebulae of the cornea. Corneal tattooing is also performed on patients who still have vision to reduce symptomatic glare associated with large iridectomies or traumatic iris loss.

Pterygium

Pterygium

pterygium is a pinkish, triangular tissue growth on the cornea of the eye. It typically starts on the cornea near the nose. It may slowly grow but rarely grows so large that the pupil is covered. Often both eyes are involved. The cause is unclear. It appears to be partly related to long term exposure to UV light and dust. Genetic factors also appear to be involved. It is a benign growth. Other conditions that can look similar include a pinguecula, tumor, or Terrien's marginal corneal degeneration. Prevention may include wearing sunglasses and a hat if in an area with strong sunlight. Among those with the condition, an eye lubricant can help with symptoms. Surgical removal is typically only recommended if the ability to see is affected. Following surgery a pterygium may recur in around half of cases. The exact cause is unknown, but it is associated with excessive exposure to windsunlight, or sand. Therefore, it is more likely to occur in populations that inhabit the areas near the equator, as well as windy locations. In addition, pterygia are twice as likely to occur in men than women. Pterygium typically do not require surgery unless it grows to such an extent that it causes visual problems. Some of the symptoms such as irritation can be addressed with artificial tears. Surgery may also be considered for unmanageable symptoms.Cochrane review found conjunctival autograft surgery was less likely to have reoccurrence of the pterygium at 6 months compared to amniotic membrane transplant. More research is needed to determine which type of surgery resulted in better vision or quality of life. The additional use of mitomycin C is of unclear effect. Radiotherapy has also be used in an attempt to reduce the risk of recurrence.  

Crosslinking

Crosslinking

Corneal collagen cross-linking with riboflavin (vitamin B2) and UV-A light is a surgical treatment for corneal ectasia such as keratoconusPMD, and post-LASIK ectasia. It is used in an attempt to make the cornea stronger. According to a 2015 Cochrane review, there is insufficient evidence to determine if it is useful in keratoconus. In 2016, the US Food and Drug Administration approved riboflavin ophthalmic solution crosslinking based on three 12-month clinical trials. A 2015 Cochrane review found that the evidence on corneal collagen cross-linking was insufficient to determine if it is an effective procedure for the treatment of keratoconus. People undergoing crosslinking should not rub their eyes for the first five days after the procedure. People that are considered for treatment must undergo an extensive clinical workup, including corneal tomography, computerized corneal topography, endothelial microscopy, ultrasound pachymetryb-scan sonographykeratometry and biomicroscopy.

PTK

PTK

Phototherapeutic Keratectomy is a surgical procedure to manage different corneal diseases. The cornea is the eye’s most outer layer and acts as a window that covers the front of the eye. PTK is a minor surgical therapeutic treatment that uses an excimer laser to treat mainly diseases of the surface of the corneal or corneal injury, by removing a small outer layer of tissue from the cornea. It is normally used after more traditional treatments have failed. It is done for therapeutic reasons, to correct documented medical eye issues.

What does the procedure involve?
In PTK the first layer of the cornea, the epithelium, is removed using an alcohol solution, the excimer laser is applied to the eye removing a thin layer. In theory, this provides a more sound base layer for healing of the erosion, allowing the corneal epithelium cells to heal all in one sheet, making the healing process more complete over the entire surface. After the surgery a contact lens bandage is put in place to provide a healing environment and reduce pain. Your surgeon will also prescribe for you a regimen of antibiotic, steroid eye drops as well as moisterising eye drops. It is important that you use the drops as these are medicine to help your eye heal and relieve any discomfort.
Is PTK the same as LASIK?
Phototherapeutic Keratectomy is very similar to laser vision correction surgery. The preparation, procedure and post-operative care are the same in both types of surgery. The main difference is that PTK is used to treat the surface level corneal disease and not to correct vision. LASIK is a vision correction procedure performed to remove the need to wear glasses or contact lenses. In LASIK a flap is created. In PTK no flap is created, and no vision correction reshaping is done.  However, PTK can sometimes be used with photorefractive keratectomy (PRK) to teat any scarring as well as to correct a refractive error, providing both a medical and cosmetic application. Your eye specialist can advise you about this procedure if your goal is also to correct your vision.
Is PTK successful?
PTK has been done for over 20 years and research studies show it is an effective treatment for corneal erosion syndrome with a success rate of over 90%. Some patients may require more than one PTK laser treatments. The laser treatment is minimally invasive and provides long-term results. PTK was approved by the U.S. Food and Drug Administration (FDA) in 1995 for the treatment of anterior corneal pathologies.
What are the risks in PTK surgery?
PTK is a safe and permanent procedure but like any form of surgery it does have a small amount of risk. This includes bacterial infection or corneal haze. These are usually mild and tend to disappear over a period of time, although they can be permanent in a small number of cases. Your eye specialist will discuss these risks with you during the consultation as well as assessing your suitability for PTK.

Keratoprosthesis (PK, DALK, DSAEK, DMEK)

Keratoprosthesis (PK, DALK, DSAEK, DMEK)

Keratoprosthesis is a surgical procedure where a diseased cornea is replaced with an artificial cornea. Traditionally, keratoprosthesis is recommended after a person has had a failure of one or more donor corneal transplants.More recently, a less invasive, non-penetrating artificial cornea has been developed which can be used in more routine cases of corneal blindness. While conventional cornea transplant uses donor tissue for transplant, an artificial cornea is used in the Keratoprosthesis procedure. The surgery is performed to restore vision in patients suffering from severely damaged cornea due to congenital birth defects, infections, injuries and burns. Keratoprotheses are made of clear plastic with excellent tissue tolerance and optical properties. They vary in design, size and even the implantation techniques may differ across different treatment centers. The procedure is done by ophthalmologists, often on an outpatient basis.

Patient selection
  • Vision should not be better than 20/200.
  • Blink and tear mechanisms should be reasonably intact.
  • Retina should be in place and there should not be extreme optic nerve cupping.
  • Consider shunt if patient is suffering from advanced stage of glaucoma.
Procedure
On the day of the procedure, the patient will arrive to the hospital or laser center where the surgery is to be performed. After a brief physical examination, he/she will be taken to the operating room. General anesthesia or local anesthesia is given before the surgery begins. An eyelid speculum is used to keep the eye open throughout the surgery. Some lubrication may be used to prevent the eye from drying. Depending on the type of keratoprosthesis used, the surgery may involve a full thickness replacement of the cornea or the placement of an intralamellar implant. For the Alphacor a manual incision is used to create a corneal pocket and a punch is used to create an opening through the posterior cornea into the anterior chamber. The Alphacor is then inserted into the corneal pocket to allow for bio-integration after several months, a second procedure is used to remove part of the anterior cornea to allow light to reach the retina. In the case of the KeraKlear, the intrallamellar pocket is created with a femtosecond laser or a corneal pocket making microkeratome. The posterior cornea is left intact. Typically, there is a follow up session few days after surgery, when patients’ complaints are addressed and modifications are made, if needed. Since Keratoprosthesis surgeries are evolving, constant attempts are being made to improve the outcome of the surgery. Also, the material and design used in the artificial cornea may vary and as a result of this, there can be minor variations in surgical procedure as well. The surgery is done on an outpatient basis with the patient returning home the same day.
Risks
Though the rate of success with Keratoprosthesis is high, in rare cases, certain serious complications could occur.
  • Glaucoma and extrusion of the implant are serious complications that could occur.
  • Sudden vitritis can cause a drastic reduction in vision. However, it is possible to treat this condition through antibiotics or by a minor laser surgery.
  • Inflammation of the eye tissue could occur. This condition is also treatable.
Usage of keratoprosthesis is typically considered when multiple donor corneal transplants have failed for a patient. A Cochrane Review found no controlled trials comparing the effectiveness of artificial corneas with donor corneas for repeat corneas transplantations.

corneal transplantation

corneal transplantation

Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently dead individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.

Risks
The risks are similar to other intraocular procedures, but additionally include graft rejection (lifelong), detachment or displacement of lamellar transplants and primary graft failure. There is also a risk of infection. Since the cornea has no blood vessels (it takes its nutrients from the aqueous humor) it heals much more slowly than a cut on the skin. While the wound is healing, it is possible that it might become infected by various microorganisms. This risk is minimized by antibiotic prophylaxis (using antibiotic eyedrops, even when no infection exists). There is a risk of cornea rejection, which occurs in about 20% of cases. Graft failure can occur at any time after the cornea has been transplanted, even years or decades later. The causes can vary, though it is usually due to new injury or illness. Treatment can be either medical or surgical, depending on the individual case. An early, technical cause of failure may be an excessively tight stitch cheesewiring through the sclera.
Procedure
On the day of the surgery, the patient arrives to either a hospital or an outpatient surgery center, where the procedure will be performed. The patient is given a brief physical examination by the surgical team and is taken to the operating room. In the operating room, the patient lies down on an operating table and is either given general anesthesia, or local anesthesia and a sedative. With anesthesia induced, the surgical team prepares the eye to be operated on and drapes the face around the eye. An eyelid speculum is placed to keep the lids open, and some lubrication is placed on the eye to prevent drying. In children, a metal ring is stitched to the sclera which will provide support of the sclera during the procedure.

Glaucoma

Trabeculotomy

Trabeculotomy

MIGS

MIGS

CPC

CPC

Endoscopic Cyclophotocoagulation

Endoscopic cyclophotocoagulation (CPC) is a procedure in which a laser, mounted on a tiny probe, is used to stun the ciliary bodyin the eye that makes intraocular fluid.  This is enabled by a tiny camera that allows your surgeon to see inside your eye behind your iris. This procedure takes about 15 minutes.  It is usually combined with other procedures.  You will go home with a patch.

Transcleral Cyclophotocoagulation

Cyclophotocoagulation (CPC) is a relatively non-invasive laser procedure for severe glaucoma.  The organ inside the eye that makes fluid, the ciliary body, is targeted with a laser that can be applied without any incisions.   The most significant risk is blurry vision, the benefits are its non-invasiveness and easy post operative period. This procedure takes about 5 minutes.  You will be briefly sedated, and during this short period your surgeon administers local anesthesia and completes the laser procedure.  You go home with a patch, which stays on until the next day.  Aching is normal during the first day, but you will be given pain medicine if you need it.   Pressure reductions are seen over the following weeks.

Canaloplasty

Canaloplasty

Canaloplasty.  Lower IOP. Fewer Drops.

Do you suffer from open angle glaucoma? Drops not working? Do you find it difficult to afford your medications or do they give you bothersome side effects?  Canaloplasty is a newer, safer surgical treatment, which has been successfully helping many glaucoma patients worldwide control their eye pressure (IOP) – many, who after surgery, no longer need their eye drops!

What is Canaloplasty

Canaloplasty is an advanced “non-penetrating” glaucoma surgery which means it does not require creation of a hole in the eye (fistula) nor does it result in a “bleb” (blister) as required with the more traditional glaucoma surgery called trabeculectomy (“trab” or short). Essentially, this surgery is like angioplasty for the eye as it uses a breakthrough microcatheter technology to restore the function of the eye’s natural outflow system. This gives canaloplasty an excellent safety profile, with early eye pressure stability after surgery and faster recovery time. It also means less activity restrictions and post-operative visits for patients when compared to trabeculectomy. As glaucoma can cause a permanent loss of vision, this procedure can provide patients with glaucoma a “peace of mind” not possible with use of glaucoma drops alone. Canaloplasty can reduce eye pressure by nearly 40%, and most glaucoma patients who have had Canaloplasty can cut their glaucoma drops in half. In some cases, Canaloplasty can even eliminate the need for Glaucoma drops.

Tube-shunt

Tube-shunt

Tube-shunt surgery or drainage implant surgery involves the placement of a tube or glaucoma valves to facilitate aqueous outflow from the anterior chamber. 

Goniotomy

Goniotomy

Kahook Dualblade Goniotomy

The Kahook Dualblade is a “minimally invasive glaucoma surgery” (“MIGS”) which can be added to cataract surgery.  Using a tiny instrument, the spongy meshwork that sits over your intraocular fluid drainage system is lifted away, thus allowing intraocular fluid directly into your drainage system.  It carries one of the least side effect profiles of incisional glaucoma surgeries and is a option for mild or moderate glaucoma.  It does not exclude other more involved surgeries later if you should need it. This procedure adds just a few minutes to your cataract surgery (total about 20 minutes).  This procedure is done under “conscious sedation” where you are awake but relaxed.  You may have transient blurring of vision after this procedure, which is often the sign of successful goniotomy procedure.  Most patients have no pain or a mild transient ache.

Viscocanalostomy

Viscocanalostomy

Viscocanalostomy is an innovative surgical treatment option for patients suffering from glaucoma. Viscocanalostomy gently opens channels within the eye that allow better fluid drainage to maintain safe intraocular pressure (IOP). Having performed several hundred procedures, our surgeons find that a high percentage of patients’ IOP is controlled without medication after the procedure. Even though high IOP which is linked to glaucoma can often be controlled with medications or laser treatments, patients may find them to be inconvenient.

Deep sclerectomy

Deep sclerectomy

High-frequency deep sclerotomy (HFDS) glaucoma surgery is a new ab interno procedure to lower the intraocular pressure in open-angle glaucoma. Using high-frequency energy, six small pockets are formed which significantly reduce the outflow resistance for aqueous humour. The pockets penetrate through the trabecular meshwork and Schlemm’s canal and end in the sclera.

Performing the High-frequency Deep Sclerotomy Procedure
  1. The anterior chamber is filled with a viscoelastic substance.
  2. Methocel is applied to the cornea.
  3. The abee tip probe is inserted through the incision and positioned at the desired point of application.
  4. The four-mirror gonioscopy lens is placed on the cornea allowing visualisation of the iridocorneal angle. Do not push on the limbus, to avoid formation of Descemet folds, which could obstruct view into the angle.
  5. Place the tip at the level of the trabecular meshwork and simultaneously press the pedal and push the tip of the probe forwards. Do not perforate. After three bleeping sounds, release the pedal and retract the abee tip from the pocket.
  6. Repeat the procedure and place five more pockets for a total of six close to each other.
  7. As with many other surgical glaucoma procedures, HFDS ab interno glaucoma surgery may lead to IOP pressure peaks within the first days post-operation. This is an absolutely common phenomenon. Avoid application of pressure-lowering drops because it can slow down the healing process. The eye pressure will reduce itself to the mid-tens mmHg and will continue to drop for a period of six months. However, the following post-operative drug regimen is mandatory: tobramycin/dexamethasone, either as a fixed-dose combination, or separately four times a day for four weeks post-operation, and pilocarpine 2 % eye drops for four weeks.

Trabeculectomy

Trabeculectomy

Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery performed and allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is absorbed. This outpatient procedure was commonly performed under monitored anesthesia care using a retrobulbar block or peribulbar block or a combination of topical and subtenon (Tenon's capsule) anesthesia. Sometimes General anesthesia will be used, in patients with an inability to cooperate during surgery.

Conclusion
Trabeculectomy is the most common invasive glaucoma surgery. It is highly effective in the treatment of advanced glaucoma as demonstrated in major glaucoma studies. Even if a prior trabeculectomy has failed a second trabeculectomy can be performed at a different site. If scarring is the main reason, anti-fibrotic and anti-inflammatory therapy has to be intensified in the second procedure. Alternatively, insertion of a glaucoma valve device can be used.

Refractive Surgery

Smile

Smile

PTK

PTK

Contact Lenses

Contact Lenses

contact lens, or simply contact, is a thin lens placed directly on the surface of the eye. Contact lenses are ocular prosthetic devices used by over 150 million people worldwide, and they can be worn to correct vision, for cosmetic, or therapeutic reasons.

Types
Contact lenses are classified in many different ways: by their primary function, material, wear schedule (how long a lens can be worn), and replacement schedule (how long before a lens needs to be discarded).
Corrective contact lenses
Corrective contact lenses are designed to improve vision, most commonly by correcting refractive error. This is done by directly focusing light so it enters the eye with the proper power for clear vision. A spherical contact lens bends light evenly in every direction (horizontally, vertically, etc.). They are typically used to correct myopia and hypermetropia. A toric contact lens has a different focusing power horizontally than vertically, and as a result can correct for astigmatism. Some spherical rigid lenses can also correct for astigmatism. Because a toric lens must have the proper orientation to correct for a person's astigmatism, such a lens must have additional design characteristics to prevent it from rotating away from the ideal alignment. This can be done by weighting the bottom of the lens or by using other physical characteristics to rotate the lens back into position. Some toric contact lenses have marks or etchings that can assist the eye doctor or the user in fitting the lens. Correction of presbyopia (a need for a reading prescription different from the prescription needed for distance) presents an additional challenge in the fitting of contact lenses. Two main strategies exist: multifocal lenses and monovision. Multifocal contact lenses (e.g. bifocals or progressives) are comparable to spectacles with bifocals or progressive lenses because they have multiple focal points. Multifocal contact lenses are typically designed for constant viewing through the center of the lens, but some designs do incorporate a shift in lens position to view through the reading power (similar to bifocal glasses). Monovision is the use of single-vision lenses (one focal point per lens) to focus an eye (typically the dominant one) for distance vision and the other for near work. The brain then learns to use this setup to see clearly at all distances. A technique called modified monovision uses multifocal lenses and also specializes one eye for distance and the other for near, thus gaining the benefits of both systems. Care is advised for persons with a previous history of strabismus and those with significant phorias, who are at risk of eye misalignment under monovision. Studies have shown no adverse effect to driving performance in adapted monovision contact lens wearers. Alternatively, a person may simply wear reading glasses over their distance contact lenses.

Lens Implant

Lens Implant

PRK

PRK

Procedure

PRK is an outpatient surgery and takes approximately 5-15 minutes per eye to complete. Although some pressure sensation may be felt during PRK, the procedure is generally painless. Before the procedure, anesthetic drops are used to numb the eye. During the procedure, an instrument holds the eyelid open and the patient is asked to focus on a target light. The surgeon then removes the surface layer of the cornea (the corneal epithelium) and uses an excimer laser to apply computer-controlled pulses of light energy to reshape the cornea.

Recovery

After PRK is completed, the surgeon inserts a bandage contact lens to protect the cornea as the epithelial layer grows back over the next 3-4 days. This also helps decrease the discomfort experienced during this time, which is generally mild to moderate and can give the sensation that a foreign body is in the eye. Patients usually experience tearing, sensitivity to light, and a moderate amount of blurred vision which may prevent driving during the first 3 days. These phenomena are typically worst on the second and third days after the procedure, but improve greatly by the fourth and fifth days as the surface layer of the cornea grows back. During this time, chilled lubricating and medicated drops are prescribed to help to decrease discomfort, heal the cornea, and decrease the risk of scar formation and infection. The cornea heals from the edges towards the center, forming a “ridge” of epithelium across the pupil where the healing tissues meet. This ridge usually has formed by the fourth or fifth day, and it is safe to remove the bandage contact lens. The vision is much improved by this time, generally ranging between 20/30 and 20/50, depending on the magnitude of the corrective treatment done. As the ridge of epithelium smoothes out over the next 4-6 weeks, the vision will gradually improve. The correction is usually considered to be stable by 3-6 months after surgery, at which time an enhancement could be considered if necessary.

PRK vs. LASIK

LASIK, PRK, AND LASEK (a variant of PRK) are surgical techniques that use precise excimer laser energy to alter the refractive status of the eye. The difference in these procedures is where the excimer laser energy is applied. LASIK consists of first making a corneal flap with a device called a microkeratome. A microkeratome is either a mechanical device that uses a blade or is laser-based. Here at Bina eye hospital, we use the Intralase laser to create LASIK flaps. After the flap is created, the excimer laser removes small amounts of underlying tissue from the exposed cornea. Following the laser treatment, the flap is placed over the eye and carefully repositioned to complete the surgery. PRK consists of mechanical removal of surface cells on the cornea (called the epithelium), followed by use of the excimer laser to remove small amounts of tissue from the front of the cornea. LASEK is simply a variation of PRK in which the surface cells (epithelium) are soaked in a dilute solution of alcohol, pushed aside as a single sheet, and then pushed back over the surface of the corneal after the laser treatment is completed. Therefore, all these operations involve use of the excimer laser to precisely remove the tissue. The primary difference is that the tissue removal is done under a flap with LASIK and on the surface of the cornea with PRK/LASEK.

Advantages of PRK/LASEK

  • PRK/LASEK avoids the use of the microkeratome or laser to make the LASIK flap. This leaves a greater portion of the cornea untouched by the surgery, which is important in patients who have thin corneas.
  • In addition, there appears to be more rapid recovery of the function of the corneal nerves, which minimizes the amount of dryness that can be present following the procedure.
  • PRK/LASEK may also provide an extra margin of safety in patients whose corneas have an unusual shape; this advantage is again due to leaving more of the cornea untouched by the surgery.
  • If eye trauma were to occur following refractive laser surgery, there is less risk of complications with PRK/LASEK than with LASIK. With LASIK, the flap, in very rare instances, can become elevated or partially dislodged if the eye is struck at just the right angle with just the right object. This problem is obviously avoided with PRK/LASEK--because there is no flap. In PRK/LASEK, the trauma may cause a surface abrasion, but without a flap the abrasion would be the same as in an eye that had not undergone any laser surgery.

Disadvantages of PRK/LASEK

  • For the first couple of days following PRK/LASEK, there can be mild to moderate eye discomfort. It takes several days for visual recovery, with good vision sometimes requiring 7-10 days, or in rare cases even longer. Depending on the rate of recovery of vision, patients can usually drive and return to work within 3 to 6 days after PRK/LASEK surgery.
  • As in LASIK, if the outcome of the original procedure does not meet expectations, retreatment can be performed. This would essentially be the same process as the original surgery.
  • PRK/LASEK patients are usually required to take cortisone drops for up to 4 months after surgery; the purpose of these drops is to minimize the risk of the development of haze in the cornea. A mild amount of haze is common, and this is not discernable by the patient. The purpose of the drops is to help prevent the development of any haze that might be noticeable to the patient.
reference : https://eyewiki.aao.org/Photorefractive_Keratectomy

Lasik/Femto Lasik

Lasik/Femto Lasik

LASIK (laser-assisted in situ keratomileusis) is an outpatient refractive surgery procedure used to treat nearsightednessfarsightedness and astigmatism. A laser is used to reshape the cornea — the clear, round dome at the front of the eye — to improve the way the eye focuses light rays onto the retina at the back of the eye. With LASIK, an ophthalmologist creates a thin flap in the cornea using either a blade or a laser. The surgeon folds back the flap and precisely removes a very specific amount of corneal tissue under the flap using an excimer laser. The flap is then laid back into its original position where it heals in place. For people who are nearsighted, LASIK is used to flatten a cornea that is too steep. Farsighted people will have LASIK to achieve a steeper cornea. LASIK can also correct astigmatism by shaping an irregular cornea into a more normal shape.  

How the LASIK procedure works

LASIK is performed while the patient reclines under a surgical device called an excimer laser in an outpatient surgical suite. First, the eye is numbed with a few drops of topical anesthetic. An eyelid holder is placed between the eyelids to keep them open and prevent the patient from blinking. A suction ring placed on the eye lifts and flattens the cornea and helps keep the eye from moving. The patient may feel pressure from the eyelid holder and suction ring, similar to a finger pressed firmly on the eyelid. From the time the suction ring is put on the eye until it is removed, vision appears dim or goes black. Once the cornea is flattened, a hinged flap of corneal tissue is created using an automated microsurgical device, either a laser or blade. This corneal flap is lifted and folded back. Then the excimer laser preprogrammed with the patient's unique eye measurements is centered above the eye. The surgeon checks that the laser is positioned correctly. The patient looks at a special pinpoint light, called a fixation or target light, while the excimer laser sculpts the corneal tissue. Then the surgeon places the flap back into position and smoothes the edges. The corneal flap sticks to the underlying corneal tissue within two to five minutes, and stitches are not needed. The patient should plan to have someone drive him or her home after the procedure and then take a nap or just relax. To help protect the cornea as it heals, the surgeon may place a transparent shield over the eye(s) to protect against accidental bumps and to remind the patient not to rub the eye(s). The patient may need to wear the shield only when sleeping. The surgeon will provide eyedrops to help the eye heal and relieve dryness. It may take three to six months after LASIK surgery for the improvements in a person's vision to fully stabilize and any side effects to go away.

LASIK risks and side effects

LASIK, like any surgery, has potential risks and complications that should be carefully considered. Since it was approved by the FDA in 1998, LASIK is has become a popular treatment in the United States and the overall complication rate is low. Infection and inflammation are possibilities, as with any surgical procedure, and usually can be cleared up with medications. Problems with the corneal flap after surgery sometimes make further treatment necessary. There is a chance, though small, that vision will not be as good after the surgery as before, even with glasses or contacts. Some people experience side effects after LASIK that usually disappear over time. These side effects may include hazy or blurry vision; difficulty with night vision and/or driving at night; scratchiness, dryness and other symptoms of the condition called "dry eye"; glare, halos or starbursts around lights; light sensitivity; discomfort or pain; or small pink or red patches on the white of the eye. In a small minority of patients, some of these effects may be permanent. Sometimes a second surgery, called a retreatment or enhancement, may be needed to achieve the desired vision correction. This is more likely for people who were more nearsighted, farsighted, or had higher astigmatism before LASIK — those whose vision originally needed more intensive correction.  
Referece : https://www.aao.org/eye-health/treatments/lasik

Retinal

Subtenon injection

Subtenon injection

Eylea injection

Eylea injection

IVT injection

IVT injection

IVB injection

IVB injection

Cryoretinopexy

Cryoretinopexy

Gas Injection

Gas Injection

scleral buckle

scleral buckle

Silicon oil Injection

Silicon oil Injection

Silicon oil extraction

Silicon oil extraction

Strabismus

Rectus recess & Rectus resect (R&R)

Rectus recess & Rectus resect (R&R)

Muscle Transposition

Muscle Transposition

Bimedial rectus recess (BMR)

Bimedial rectus recess (BMR)