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144188195215245280

M.S. Sridhar

Chennai, Tamil Nadu
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He was Consultant (Cornea, Cataract and refractive Surgery) & In charge of LASIK surgery at L.V. Prasad Eye Institute, Hyderabad, India.
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Femto Cataract Surgery
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Femto Cataract Surgery

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Considerable advances have happened in the field of cataract surgery to optimize surgery outcome and deliver patient his/her required functional vision. Femtosecond laser has been used in cataract surgery to replace several manual steps making the procedure safe and reproducible.

The Femtosecond laser is used to create the entry wound for cataract surgery. The corneal entry wound created by Femtosecond laser is stable and consistent. The Femtosecond laser has also ability to make cuts on the Cornea correcting the pre-existing corneal power or astigmatism, helping the patient to have clear vision without glasses. Femtosecond laser is used make the capsulotomy or circular opening in the anterior capsule, which is the initial entry into the natural opaque lens. The circularity and the centration of the anterior capsular opening are better when done with Femtosecond laser compared to the manual procedure. The success and visual refractive outcomes following premier IOL cataract surgery including Toric, Multifocal & Accomodative IOLs depends on the appropriate centration and anterior capsule overlap. The Femtosecond laser is also used to soften the hard nucleus with resultant less stress on the cornea and quicker visual recovery. Lens fragmentation using Femtosecond laser reduces the phacoemulsification time with increased safety of capsular integrity during lens removal. Reduction in the amount of ultrasound energy following the Femtosecond laser reduces the risk of capsule complications and corneal endothelial injury.

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Femto LASIK
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Femto LASIK

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Femto LASIK is an advanced form of LASIK surgery in which the corneal flap is created by the Femtosecond laser and the corneal ablation (tissue removal) to correct the power is done by Excimer laser. Since the procedure is done with two lasers and no microkeratome is used to make the flap, Femto LASIK is also called bladeless LASIK. The Femtosecond laser is an infrared laser which creates hot plasma to make the intrastromal cut and also vertically the side cuts. Unlike the blade which is fitted into the microkeratome, the head of the microkeratome moving on the suction ring applied over the cornea, Femto LASIK involves gentle docking. The following are the advantages of Femto LASIK over microkeratome (with blade LASIK)
  • The flap thickness is predictable and hence fewer incidences of serious complications like ectasia.
  • The flap is uniformly thick (planar flaps) unlike the meniscus flaps obtained with microkeratome .The planar flaps are most stable.
  • The incidence of surface epithelial defects is very low and hence can be used even in conditions like anterior basement membrane dystrophy in which microkeratome LASIK is not suggested.
  • The healing in Femto LASIK is stronger and hence better adhesion of the edge and interface resulting in less risk of flap dislocation. Femto LASIK induces less high order aberrations making customized treatment more useful to the patient.
  • The flap morphology is circular and with a programmed edge and the stability of flap is better with Femto LASIK
  • In Femto LASIK with planar flaps and well defined cut angles result in precise re alignment of flaps.
  • In Femto LASIK we can cut thinner flaps with reduced amount of tissue nerve degeneration.
  • The incidence of dry eyes seems to be less in Femto LASIK compared to microkeratome LASIK.
  • Femto LASIK results in faster visual acuity and better visual outcome with resultant superior contrast sensitivity. Enhancement of Femto LASIK is less compared to microkeratome LASIK.

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Corneal Collagen Crosslinking
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Keratoconus is a relatively frequent disease often affecting young patients. The biomechanical resistance of the Cornea in Keratoconus patients is half the normal value. Treatment based on Collagen cross linking with the help of ultraviolet (UV) and the photosensitizer Riboflavin has been introduced by Wolloensak. This treatment is aimed at the pathogenic cause of Keratoconus and changes the intrinsic biomechanical properties of corneal collagen. The method of corneal cross linking using Riboflavin and UV-A is technically simple and less invasive than all other therapies proposed for Keratoconus.

Crosslinking is a commonly employed method in polymer industry to harden materials and in bioengineering to stabilize tissue. For example, chemical crosslinking with Glutaraldehyde is used in the preparation of prosthetic heart valves and physical crosslinking by UV-A is often used in dentistry to harden filling materials. Similarly tissue specimens are preserved and hardened by Glutaraldehyde or Formaldehyde in pathology. Using UVA at 370 nm and the photosensitizer Riboflavin, the photosensitizer is excited to its triplet state generating so-called reactive oxygen and to a much lesser degree superoxide anion radicals. The ROS can react further with various molecules including chemical covalent bonds bridging amino groups of collagen fibrils (type II photochemical reaction).The wavelength of 370 nm has been chosen because of an absorption peak of Riboflavin at this wavelength.

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Implantable Collamer Lens
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You would have come across many different solutions such as Glasses, Contact lens and even LASIK - for the correction of short sight and long sight. In the same breath, there is also a state – of –the-art solution called Visian ICL which is gaining popularity as a superior option to the above said mundane solutions.

Visian ICL is type of lens which is inserted in to the eye – permanently – in a small procedure which lasts about a few minutes, and is not required to be removed often as in case of any other contact lens.

From Glasses to Contacts to LASIK, the Visian ICL ushers in the next generation of vision technology. Many vision correction procedures promise an improved level of vision, but few can promise the level of quality found with the Visian ICL. It’s called High Definition Vision; it’s sharper, clearer, with greater depth and dimension.

Visian ICL stands for Visian Implantable Collamer Lens or simply ICL.

It derives its name from material which it is made out of - “Collamer” which is proprietary to STAAR Surgical. Since Visian ICL is made out of Collamer, it is 100% compatible with your body’s natural chemistry. Among collamer’s advantages are Anti-glare and UV protection to your eyes. The Visian ICL is the best choice for a lens that is going to remain in your eye for a lifetime.

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Cataract Surgery
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Cataract Surgery

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Cataract is that condition of the eye where the clear natural lens become opaque and affects the vision. It is caused by various factors like age, heredity, ultraviolet light exposure, injury, diabetes and medications like steroids.

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LASIK Surgery
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LASIK Surgery

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LASIK (Laser Assisted In Situ Keratomileusis) is an advanced laser vision correction technique and an attractive option to remove spectacles where the curvature of the cornea is altered using laser.

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Dry Eyes
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Dry Eyes

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Dry eye (DE) is a disorder of tear film due to tear deficiency or excessive tear evaporation causing damage to the interpalpebral ocular surface and associated with symptoms of ocular discomfort. Dryness leads to tear film hyperosmolarity. Ocular surface inflammation is considered an end result.

DE is classified into 2 major groups : Tear deficient DE and evaporative DE. Tear deficient DE is a disorder of lacrimal function or can result from failure of transfer of lacrimal fluid into the conjunctival sac, resulting in a reduction in the flow of tears and a fall in the volume of tears in the conjunctival sac. It is the largest category of DE and is divided into two sub-groups: Sjogren’s syndrome (SS) tear deficiency and non-SS tear deficiency is an exocrinopathy affecting the lacrimal and or salivary glands, which may be primary or secondary.

Primary SS consists of features of ATD in combination with a dry mouth, the presence of auto antibodies and a positive focus score on minor salivary gland biopsy. Secondary SS consists of the afore mentioned features in conjunction with the clinical manifestations of an autoimmune connective tissue disorder. In non-SS tear deficiency, there are no systemic or clinical manifestations of autoimmune disease, which are the hallmarks of SS tear deficiency. The causes of secondary SS and non-Sjogren's dry eyes is shown in table I

In evaporative or tear sufficient DE, lacrimal function is normal and in most cases, the tear abnormality is due to increased tear evaporation. Meibomian gland (MG) dysfunction and blinking disorders are common causes for evaporative DE.

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Corneal Transplantation
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Corneal Transplantation

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Corneal transplantation is a surgery where the central 7-8mm of affected cornea is removed and replaced with a cadaver cornea. The usual indications for corneal transplantation include keratoconus, failed corneal transplantation and corneal swelling following cataract surgery. Now a days efforts are being made to replace only the affected layer of cornea through lamellar surgery.

In Amniotic membrane transplantation, a thin layer of processed amniotic membrane is applied to promote healing. This procedure is used in non- healing corneal ulcers, chemical injuries and recurrent pterygium.

Corneal stem cell transplantation is a procedure where corneal stem cells are replaced in conditions where there are reduced or total loss of stem cells. Stem cells from the other eye or from related donors is used in this procedure.

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Keratoconus
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Keratoconus

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Keratoconus is a condition where the cornea thins and  protrudes forwards causing decreased vision.Vigorous eye rubbing in agenetically predisposed individual is known to cause Keratoconus. The treatment of Keratoconus include glasses, different kinds of contact lens(RGP corneal contact lens and sclera contact lens) and intracorneal rings(Intacs). In patients with no visual improvement with these modalities corneal transplantation( lamellar or full thickness surgery).
Collagen cross linking is the only modality available for preventing the progression of Keratoconus. In this procedure, Riboflavin drops are applied and the eye is exposed to ultraviolet rays. This induces the release of singlet oxygen which causes cross linking of collagen and hence strengthening of cornea.

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He was Consultant (Cornea, Cataract and refractive Surgery) & In charge of LASIK surgery at L.V. Prasad Eye Institute, Hyderabad, India.

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