LOTUS EYE CARE HOSPITAL

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LOTUS EYE CARE HOSPITAL LAUNCHED BLADE FREE
INTRALASE LASIK/ ZYOPTIX TECHNOLOGY
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FEMTOSECOND
(This definition follows U.S. usage in which a
billion is a thousand million and a trillion is a
1 followed by 12 zeros.) A Femtosecond is one
millionth of a nanosecond or 10 -15 of a second
and is a measurement sometimes used in laser
technology
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LIGHT SPECTRUM
Wavelength (µm)
Television
Short Wave
Lasers
Microwaves
FM Radio
AM Radio
Thermal/Heat Radiation
Ionizing Radiation
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LASER SPECTRUM
700 nm
100,000 nm
100 nm
400 nm
INTRALASE FS
Ultraviolet
Visible
Infrared
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INTRALASE FS laser

• Femtosecond laser
• (NdGlass) 1053 nm (near infrared)
• Each pulse of focused laser light lasts
  approximately 10-15 seconds (500-800 femtoseconds)

• In one second, light travels 7.5 times around the
  globe
• In 100 femtoseconds, light travels across a human
  hair
• Power Energy/Time, extremely high power
  attained at relatively low energy

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INTRALASE - FS 60
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INTRALASE - FS 60

• Model- FS 60
• Repetition Rate- 60kHz
• Energy per pulse - gt or equal to 1uJ
• 9mm flap time 17- 20 Degree
• Hinge Angle - 30-90 Degree
• Hinge location - Variable
• Procedures - Flap, AK, Wedge, ICR, IEK, LK

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INTRALASE - FS 60

• Flap Shape - Planar
• Visual Procedure Control - Yes
• Cut Direction - Interface first
• Focus - X, Y, Z
• Flap Thickness Control - Computer 90-400 uM
• Diameter Control - Computer
• Cut Pattern - Raster/Spiral
• Side cut angle - Computer 30-90

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INTRALASE - FS 60

• Beam pattern - Continuous
• Centeration control -Computer software
• IOP increase vs microkerotomes -low
• Loss of sight during suction -Yes
• Docking arm - Automated
• Mobile - No

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LASIK / ZYOPTIX

• Step 1 Creating corneal flap
• Step 2 Folds the flap back and perform laser
  procedure which corrects vision .

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CORNEAL FLAP

• Accuracy of thickness
• Flap Stability
• Nice / Sharp edges
• No complication
• Patient comfort during flap creation

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HOW DO WE CREATE..

• Equipment - Microkeratome
• Tissue cut by Blade
• Desired thickness - Blade Holder
• Flap Diameter Suction ring
• IOP increases gt 65mmHg
• Total Time of Increased IOP 60-80 sec.

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LIMITATION

• Meniscus flap Non Uniform
• Flap Thickness 10 -35 µ
• Flap Diameter
• Steep corneas
• Deep set eyes
• Thin corneas with Higher ref correction

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BLADE MICROKERATOME COMPLICATIONS

• Microkeratome complications occur in up to 10
  percent of all LASIK procedures, including the
  most serious complications that may affect the
  visual outcome of a LASIK procedure (Ambrosio and
  Wilson, Osman).

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POSSIBLE COMPLICATIONS

• Partial and Incomplete Flaps
• Free Flap
• Button Hole
• Suction Loss
• Epithelial Abrasion.
• Diff. thickness at different curvatures.
• Dry eye Problem

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POSTPONE .????

• If any of the Flap related complication occurs
  like incomplete flap, Button Hole, etc., the only
  option left is to reschedule the surgery.

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INTRALASE Blade free method Flap creation

• Intralase FS laser is an advanced technology and
  represents a major improvement in LASIK surgery.
• Offers versatile capability and flexibility in
  customizing flap creation with even, clean edges,
  regardless of the size or shape of the eye.
• With programmed parameters, the Intralase
  performs exactly as programmed with precise,
  predictable outcomes, transforming the science of
  creating the corneal flap into an artful
  application of technology.
• Patient Comfort -fast surgical procedure hence
  there is no trauma to the eye, no patient
  discomfort, patients tend to be very relaxed
  during the surgery, confident that the laser is
  performing as expected.

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LOWER IOP

• The suction ring used with the INTRALASE FS Laser
  creates an intraocular pressure (IOP) of
  approximately 40 mm Hg.
• In contrast, the suction ring used with a
  microkeratome raises IOP to 80 mm Hg or more, a
  much higher and potentially less safe level.

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FLAP THICKNESS

• Desired flap thickness accuracy 5-10µ
• In reality the thickness 3-8µ

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UNIFORM FLAP THICKNESS

• The entire Cornea is applanated (flatten)
  uniformly then the laser works on planner
  surface.
• The Highly precise Laser pulses focused to
  precise intrastromal locations.
• Flap is always uniform thickness from side to
  side .
• Furthermore the uniform thickness and Vertical
  cleavage plane fits the flap like a manhole
  cover, minimise the chance of flap slippage or
  wrinkling if accidentally rubbed or bumped during
  healing after surgery.

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IMMEDIATE REPETITION WITH NO ADVERSE EFFECTS

• If the surgeon encounters a loss of vacuum during
  flap creation with the Intralase laser, the flap
  creation can be repeated immediately with no
  known adverse affects.
• In contrast, complications occurring during the
  creation of a flap with a microkeratome may
  require three months of healing before a repeat
  procedure can be attempted.

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REDUCED RISK OF COMPLICATIONS

• As there are little to no possibilities of
  corneal abrasion, such situations as thin flap,
  thick flap, partial flap, incorrect diameter or
  buttonhole flap can be addressed.
• In addition, with the resulting flap has uniform
  thickness across the diameter, use of the
  IntraLASIK approach is ideal for hyperopes, large
  pupils, moderate to high astigmatism, and small
  corneal diameters where producing a large enough
  flap for a blend zone is an issue.
• Producing a uniform ablation far into the
  periphery is critical in these cases.

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EPITHELIAL INGROWTH -
CONTROLLED

• Further, the lasers ability to create a very
  thin flap maintains optimal stromal bed thickness
  when treating higher refractive errors or thinner
  corneas.
• Because the IntraLASIK software enables the laser
  to produce flaps with vertical edges, it is more
  difficult for epithelial cells to migrate down
  under the flap into the interface since the
  length of the route for those cells is increased.

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EXCEPTIONAL SURGEON CONTROL

• Surgeons gain exceptional control in the creation
  of corneal flaps.
• The computerized IntraLASIK software allows the
  surgeon to set predictable controls for micron
  precision and consistency in flap diameter,
  depth, hinge location and width and side cut
  architecture, which varies by individual patient
  corneal anatomy.
• Such precision virtually eliminates corneal flap
  complications.

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INTRALASE IN EYE SURGERY
Intralase is not only used for Lasik for glass
free vision but also for treatment of conical
(keratoconus) cornea and corneal (eye)
transplants for better results
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PATIENTS GAIN CONFIDENCE

• Patients gain confidence in choosing vision
  correction surgery.
• The higher degree of comfort and safety,
  virtually no risk of complications, and more
  predictable outcomes increase patient
  satisfaction in their experience and outcome.

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CONCLUSION

1. Major advancement in lasik
2. Higher degree of safety and precision
3. Predictable outcome
4. Faster visual recovery
5. Increased patient satisfaction and comfort
6. Enhanced quality of vision
7. Approved by FDA, NASA for astronaut and US air
   force

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