http___metro-portal.hr_lasersko-skidanje-dioptrije-odgovori-na-cesto-postavljena-pitanja_60965_1.xml
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LASIK procedure of laser vision correction There are several methods of laser vision correction. All methods have one thing in common. Using a laser the refractive power of the cornea changes which permanently removes the diopter and provides a clear image without wearing spectacles and contact lenses. Corneal surface is covered with a thin epithelial cell layer which has a protective role (like an epithelium in all tissues). Epithelial cells are rapidly renewing making it impossible to apply the laser directly on the surface of the cornea. Because of that it is necessary to avoid the superficial epithelial layer and apply the laser rays to the corneal tissue beneath the epithelium. Depending on how this is achieved we can distinguish lamellar procedures to surface ablation procedures. LASIK method is the most commonly performed method of laser vision correction and more than 20 million people worldwide have done it. Its great popularity among patients owes to the fact that it is completely painless, it takes only five minutes per eye, and the next day patients achieve a satisfactory quality of vision, which becomes quite clear in a few days after the intervention. It consists of separating the surface layer of the cornea and making the cover or the so-called "flap", which remains attached to the cornea with one part. Flap is made using a special device called microceratom. Then the "flap" is lifted and highly sophisticated laser rays are applied on corneal tissue to change the corneal refractive power, i.e. to remove the diopter. At the end, the flap is put back and immediately starts healing. LASIK method and other methods of laser vision correction are performed under local, topical anesthesia. Painless procedure is achieved by instillation of the eye drops. After laser vision correction more than 95% myopic, and over 92% patients with hyperopia is completely free from wearing glasses or contact lenses. The incidence of complications is 0.5 to 1% and the vast majority of complications heal for several days with adequate therapy. This is primarily to mild sterile inflammation of the cornea, eye dryness, and transient damage to the epithelium, the superficial layer of the cornea. Serious complications that require treatment, primarily due to the infection, are extremely rare. Their frequency is 1 in 5000 (0.02%), which is the frequency of infections that occur in contact lens weareres. Another complication is corneal ectasia, localized weakening of the cornea, which became even more uncommon complication than infection (less than one in 5,000 patients) with the development of diagnostic devices such as the WaveLight Oculyzer. According to the official survey of the European Society of Refractive Surgery (ESCRS) from 2010. , 98 percent of patients who have undergone LASIK laser vision correction would recommend this laser vision correction to others. LASIK can correct the refractive error from -10D to +6 D and astigmatism up to 6 diopters. For diopter outside this range, there are other methods of refractive surgery, especially in the form of installation phakic lens. Detailed overview of LASIK intervention What can you expect before and during the LASIK procedure If the preliminary examination determines you as a candidate for LASIK vision correction, you will be told the exact date and time of the intervention. The arrival is usually 30 minutes before the procedure and it involves brief checking of the diopter and once again explaining the procedure to the patient. After checking the refractive error, in a special section for the preparation, the nurse will instill the anesthetic. By instillation of the anesthetic, procedure becomes completely painless, and during surgery the patient feels just a touch. After the preparation, you enter the laser room and lie on the bed of the laser system. During the whole procedure, the laser head is above you and you're looking at a green light . You shouldn’t worry if you move your eye focus, because Allegretto Wave ® Eye-Q Laser has a highly sophisticated eye tracker system that tracks eye movements at a speed of 400 movements per second. Then we put you a gentle holder for eye lids, so that you can’t blink during the procedure. Then, using microceratom, we separate the superficial part of the cornea in the form of cover (flap), reveal the tissue of the cornea and apply laser rays. When creating flap, patient feels a slight pressure and loses the light on the eye for 10 seconds and it is the only unpleasant part of this painless LASIK procedure. After lifting the flap, and revealing the corneal stroma, a small, high-speed laser beams are used to reshape the cornea and remove the diopter. It takes only two seconds to remove one diopter with Allegretto Wave Eye Q laser. At the end of the procedure, surgeon puts the flap back to its place and it heals within one day by itself, without the need for any sutures. Immediately after the LASIK procedure: Patients immediately notice better vision than before the intervention. But that vision, right after the surgery is rather watery. The next day, very good visual acuity is achieved, which causes the greatest enthusiasm among patients and is known as the so-called'' WOW'' effect. In most patients, highly clear vision is achieved after two to three days after the intervention. At the end of the procedure you will stay at the clinic for another 30 minutes to make sure that everything is okay and then you can go home. Total stay in the clinic is about an hour and a half. You should bring sunglasses with you to put them on after leaving the clinic and prevent eye irritation with substances from the environment. Some patients are disturbed by bright light, in the first few hours after the surgery and that is another reason why they should bring their sunglasses. Before you leave the clinic you will be informed about the time of the first postoperative follow-up. First day after the surgery it is recommended that you: Sleep or keep your eyes closed the first few hours after the intervention Use artificial tears every hour or two Avoid rubbing the eyes Wear sunglasses if light disturbes you You will get protective transparent plastic “shell”, which you can use during the night, in order to avoid accidentally rubbing your eyes The second follow-up is seven days after the intervention. In the first few days, it is forbidden to wash your face with tap water, but for this purpose you may use saline or unopened bottled water. In this period it is also advised to avoid dusty, dirty and smoky areas. Due to dryness of the eye, you should avoid working at the computer for several hours in the first seven days or if it is not possible, it is advised to make a break every 30 to 45 minutes. You will get antibiotic drops that you will use in the first two weeks as well as artificial tears which you will use the first two months. After the first week: You are able to get back to your usual work activities and return to work (return to work is possible after only 3 days) Although the vision for most patients is very clear, after a few days of intervention, at one moment it could be crystal clear but in another slightly blurred. This is totally normal in the postoperative period and it is the consequence of the dry eye that occurs in most patients. After instillation of artificial tears, it immediately becomes clear and sharp again. This is not something that constrains patients in work and other activities, and passes when the tear film is recovered, usually up to one month after the intervention. During this period, for the same reason some patients may notice transient phenomenon of glitter, the so-called halo around the observed light source. Three to four weeks you should avoid heavy physical activity, swimming pools and sea. During the first month it is forbidden to rub your eyes The third follow-up is one month after the treatment, then after six months, and then the follow-ups on an annual basis. Over 99% percent of patients do not experience any complications and gain vision as they had with glasses and contact lenses. The only major difference is that you no longer need glasses or contact lenses. Since LASIK is a method much more comfortable for patients because of its complete painlessness and faster visual recovery, 90% of patients undergo LASIK laser vision correction. PRK method is for patients who have some contraindications for LASIK because of thin corneas or the existing irregularities of the cornea. In these cases, although LASIK is contraindicated, the diopter can be removed by PRK method, due to the fact that it does not include making the flap, the separation of superficial layers of the cornea, so the changes in the biomechanics of the cornea are less. Changes in corneal biomechanics after LASIK, in most patients have no practical significance, but for those with thin corneas should be avoided, and for this reason PRK method is suggested. Alternative procedures for removing the diopter Laser vision correction shows the best results when diopters are from -10 to +6 and up to 6 diopters of astigmatism. For patients who are out of range of values, or the characteristics of the cornea are not adequate so the laser vision correction is not recommended, there are more appropriate options in the form of installation phakic lenses for patients who are not over 40 years old. For patients over 40 years who already need glasses for reading, we recommend implantation of the multifocal lenses. On the next page you can find out more about the technology and equipment for laser vision correction.
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Lasersko skidanje dioptrije - odgovori na često postavljena pitanja Ako su vam dosadile naočale ili leće i željeli biste se baviti sportom, svojim hobijima ili poslom bez naočala - ima odličnih rješenja! Poznato je da naočale, pogotovo pri većoj dioptriji, sužavaju vidno polje, a dugotrajno nošenje kontaktnih leća kod nekih osoba može izazvati iritaciju, alergije te upale ili nemogućnost prilagođavanja oka kontaktnoj leći. U posljednjih je desetak godina upravo oftalmologija toliko napredovala da su laserske korekcije vidne oštrine postale gotovo rutinske i predstavljaju jednostavno rješenje skoro za svakoga. Ako se još uvijek niste odlučili na taj značajan korak u vašem životu, jer vas je strah operativnog zahvata, ishoda operacije, ili pak imate cijelu listu pitanja na koja ne možete pronaći odgovore, dr. sc. Nadežda Bilić iz Poliklinike Bilić Vision u Zagrebu, specijalist oftalmolog s osmogodišnjom praksom u laserskoj korekciji vida i prva žena refraktivni kirurg u Hrvatskoj, odgovara na neka od najčešće postavljanih pitanja u vezi s laserskom korekcijom vida. Najčešće procedure laserskog skidanja dioptrije su LASIK (laser-assisted in situ keratomileusis i PRK (Photorefractive keratectomy). Lasik je metoda kod koje se mikrokeratomom (oscilirajući nožić pokretan elektromotorom) ili laserski, formira poklopčić u sloju rožnice, nakon čega se isti podiže da bi se uz pomoć laserskih zraka modelirala rožnica i odstranila dioptrija. Oporavak je brz, a povratak na radno mjesto moguć je praktički unutar 24 sata. Kod metode PRK nema formiranja poklopčića rožnice što smanjuje mogućnost komplikacija vezanih uz poklopčić. Kod ove metode se mehanički ili laserom odstranjuje površni epitel rožnice, a nakon toga excimer laserom modelira rožnica i odstranjuje dioptrija. Metoda je sigurnija od Lasika, no oporavak vida do normale traje i do 3-4 tjedna, a može se primjeniti samo kod kratkovidnosti do -6,0 dioptrija i manjeg astigmatizma do 1,0 dioptriju. Uglavnom se preporuča kada je rožnica tanka (ispod 550 mikrometara). Prednost joj je i u tome što je pojava suhog oka izražena u znatno manjem postotku u odnosu na Lasik. Ipak, najčešće pitanje refraktivnom kirurgu nije koju proceduru izabrati već: Je li postupak bolan? Lasersko skidanje dioptrije je bezbolno. Manju neugodu može izazvati pritisak na oko koji se javlja kod formiranja poklopca, ali traje svega 10-15 sekundi. Nekoliko sati poslije operacije može postojati lagani osjećaj stranog tijela, suzenje i sl. Takvi simptomi vrlo brzo se gube korištenje propisanih protuupalnih lijekova i umjetnih suza. Možete li mi garantirati 100% vidnu oštrinu poslije operacije? Bilić izvodi lasersku operaciju oka Nije moguće dati takvu garanciju. Ipak iz mog osmogodišnjeg iskustva bavljenja laserskom kirurgijom možemo predvidjeti da će oko 95% pacijenata postići normalan vid, tj. onakav kakav su imali prije operacije uz nošenje naočala ili kontaktnih leća. Takav dobar rezultat postići će uglavnom oni s manjom i srednjom kratkovidnošću i dalekovidnošću te oni s umjerenim astigmatizmom. Ukoliko je dioptrija visoka (od-8,0 do -10,0 Dptr.) postoji veća mogućnost povratka manjeg dijela dioptrije. Tu je dioptriju moguće odstraniti nakon 3-6 mjeseci od operacije ukoliko je ostalo dovoljno tkiva rožnice nakon prvog zahvata. Ukoliko ponovna operacija nije moguća, takvi pacijenti ostatak dioptrije korigiraju kontaktnim lećama ili naočalama, a u najvećem broju slučajeva takva potreba se javlja samo u određenim situacijama (npr. vožnja). Kad se mogu vratiti na posao? Poslije Lasika u pravilu nakon 24 sata, dok je poslije PRK oporavak vidne oštrine duži i traje oko 2 tjedna. Kada mogu voziti? U pravilu već sljedeći dan nakon Lasika, no moj je stav da pacijent treba pričekati s vožnjom nekoliko dana, pogotovo ako je imao visoku dioptriju, radi prilagodbe na novonastalo stanje. To znači da za volan treba sjesti onda kada osjeti da je sposoban za vožnju i da dobro vidi bez oscilacija u vidu. Mogu li se oba oka operirati isti dan i kod Lasika i kod PRK? U pravilu mogu, no kod PRK zbog sporijeg oporavka vidne oštrine odlučuje se na individualnoj bazi. Mogu li se po potrebi nositi kontaktne leće nakon laserskog skidanja dioptrije? Neznatan broj pacijenata imat će potrebu za nošenjem kontaktnih leća nakon Lasika ili PRKa, no oni koji će željeti eventualnu preostalu dioptriju korigirati kontaktnim lećama moći će to bez problema učiniti ukoliko je zakrivljenost rožnice unutar normalnih granica. Mogu li od laserske operacije oslijepiti? Zbog lasera ne možete oslijepiti. Nigdje u literaturi nije zabilježen slučaj sljepoće kao posljedice laserskog skidanja dioptrije. Može li laser oštetiti neki dio moga oka? To nije moguće, jer zbog valne duljine excimer lasera, laserske zrake prodiru samo do najviše polovine debljine rožnice, tako da su dublje strukture oka, očna leća, vidni živac ili žuta pjega sigurni prilikom ovih procedura. Može li nešto poći krivo ako trepnem, kihnem, zakašljem se i sl. To nije problem. Iskusan operater te moderna tehnologija lasera omogućuju preciznost i sigurnost postupka. Koliko dugo traje suhoća oka nakon Lasika? Može potrajati i do šest mjeseci, pa je potrebno oko ovlaživati umjetnim suzama u količini koju preporuči liječnik. Bez obzira na još uvijek prisutne strahove i donekle rezerviranost pacijenata prema laserskom skidanju dioptrije, treba ipak naglasiti da je metoda sigurna u preko 99% slučajeva, a da su preostalih 1% ipak više nuspojave nego komplikacije koje ostaju trajno. To se prvenstveno odnosi na suho oko, moguću infekciju, uraštanje epitelnih stanica pod poklopčić, osjetljivost na svjetlo, razlijevanje slike pri vožnji noću i. sl., jer većina takvih simptoma spontano nestaje nakon nekoliko tjedana ili mjeseci. dr. sc. Nadežda Bilić, specijalist oftalmolog Poliklinika Bilić Vision, Ksaverska cesta 45, Zagreb www.bilicvision.hr