Corneal refractive surgery
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1 Miltos Balidis PhD, FEBOphth, ICOphth Corneal refractive surgery Symposium of the Hellenic Society of Intraocular Implant and Refractive Surgery Cairo, 14/3/2018 1
2 Professional standards for refractive surgery Long term results Ectasia Out of the box Considerations 2
3 Long-term results of superficial laser in situ keratomileusis after ultrathin flap creation George D. Kymionis, MD, PhD, Nikolaos Tsiklis, MD, Aristofanis I. Pallikaris, PhD, Vassilios Diakonis, MD, George Hatzithanasis, MD, Dimitra Kavroulaki, MD, Mirko Jankov, MD, Ioannis G. Pallikaris, MD, PhD Journal of Cataract & Refractive Surgery Volume 32, Issue 8, Pages (August 2006) DOI: /j.jcrs Journal of Cataract & Refractive Surgery , DOI: ( /j.jcrs ) Copyright 2006 ASCRS and ESCRS 3
4 Journal of Cataract & Refractive Surgery , DOI: ( /j.jcrs ) Copyright 2006 ASCRS and Long-term results of laser in situ keratomileusis for high myopia: Risk for ectasia Patrick I. Condon, MCh, FRCS, FRCOphth, Michael O'Keefe, MCh, FRCS, FRCOphth, Perry S. Binder, MD Journal of Cataract & Refractive Surgery Volume 33, Issue 4, Pages (April 2007) DOI: /j.jcrs Copyright 2007 ASCRS and 4
5 UCVA 5-7 years Journal of Cataract & Refractive Surgery , DOI: ( /j.jcrs ) Copyright 2007 ASCRS and ESCRS BCVA 5-7 years Journal of Cataract & Refractive Surgery , DOI: ( /j.jcrs ) Copyright 2007 ASCRS and 5
6 Figure 6 Journal of Cataract & Refractive Surgery , DOI: ( /j.jcrs ) Copyright 2007 ASCRS and ESCRS Risk Assessment for Ectasia after Corneal Refractive Surgery J. Bradley Randleman, MD, Maria Woodward, MD, Michael J. Lynn, MS, R. Doyle Stulting, MD, PhD Ophthalmology Volume 115, Issue 1, Pages e4 (January 2008) DOI: /j.ophtha Copyright 2008 American Academy of Ophthalmology Terms and Conditions 6
7 Ophthalmology , e4DOI: ( /j.ophtha ) Copyright 2008 American Academy of Ophthalmology , e4DOI: ( /j.ophtha ) Copyright 2008 American Academy of Ophthalmology Terms and Conditions 7
8 Figure 11 Ophthalmology , e4DOI: ( /j.ophtha ) Copyright 2008 American Academy of Ophthalmology Terms and Conditions PTA 8
9 LVA Only option Scars Post viral subepithelial infiltrates Basement membrane or anterior stromal dystrophies Combined PTK / PRK OCT for scars PTK with viscoelastic masking Treat the underline cause Treat the preexisted or induced refractive error 9
10 Refraction irregularity Transparency Hyperopic shift after PTK Laser physics Biomechanics Biological response Smoothening of surface 10
11 Solution 20μm PTK 1 D hyperopic treatment 40μm PTK and masking 1 d hyperopic treatment Peripheral CXL? 11
12 LVA not an option Advanced presbyopia? Younger than 18 years? Autoimmune disease? OSD? 12
13 A good candidate for LASIK must be at least 18 years of age, have a stable refraction and healthy corneas 13
14 RLE is not an option Younger than 50 Low myopes High astigmats Picky patient 14
15 15
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