اعمال جراحی انکساری PRK ، لیزیک ، لازک ، فمتو لیزیک و اسمایل اعمال جراحی انتخابی برای کاهش وابستگی به عینک هستند که از طریق تغییر انحنای قرنیه با اشعه لیزر می توانند عیوب انکساری مانند نزدیک بینی ، دوربینی ؛ و آستیگماتیسم را اصلاح نمایند . بیش از دو دهه از انجام این اعمال جراحی می گذرد و تاکنون چشمهای زیادی در سرتاسر دنیا تحت این عمل قرار گرفته اند . با این اعمال جراحی که امروزه نسبت به سالهای گذشته پیشرفت های زیادی داشته اند میتوان محدوده نسبتا وسیعی ازاختلالات انکساری چشم را برطرف کرد و یا به حداقل رساند .
قبل از هر چیز باید دانست که انجام این اعمال جراحی چیزی به سلامتی چشم اضافه نمی کند و فقط میتوان بواسطه این جراحی ها وابستگی به عینک و یا لنز تماسی را به حداقل رساند . انجام این جراحیها هم مانند سایر جراحیهای دیگر وابسته به یکسری فاکتورها و شرایط هست و ممکن است برای بعضیها قابل انجام وبرای بعضیها قابل انجام نباشد . People who have other diseases in their eyes in addition to refractive error or suffer from some chronic diseases in other body systems may not be suitable candidates for refractive error correction surgery and LASIK.
Realistic expectations in LASIK (LASIK ), LASEK (LASEK ) and (PRK )
one of the prerequisites In other conditions, all vision science specialists consider it necessary to subject a person who is applying for refractive error correction surgery to such surgeries, having appropriate expectations. This is because, although LASIK, LASEK, and PRK surgery have relatively high accuracy and health, the results are not perfect in all people.
For many, the main goal is to reduce dependence on glasses or contact lenses, not to remove them. That is, instead of the constant and 100% need for glasses, they have aimed to use glasses in some limited situations such as long reading or driving at night. Of course, it is true that many people who have undergone such surgeries no longer need glasses, but this has not always been true and will not be the case. Even in cases after the operation (for example, in people with old eyes) a person needs two glasses instead of one, although the duration of their use has been significantly reduced compared to before the operation.
We should know that people with glasses, although they are very similar in terms of the need for glasses, but in many other ways, such as the amount and type of eye weakness, age, and their physical responses to surgical intervention, they are very different. These are the differences that will make the result relative. The right expectation is to accept these differences and relativity so that we don't have problems and regret after the operation.
The factors that must be taken into consideration to perform these actions are:
1- The minimum age of the person must be 18 years and the person's eye score has not changed for at least one year since the last examination. Therefore, the most important factor is the stopping of growth and the stability of the eye score.
2- To perform For refractive surgery, factors such as people's age, amount and type of weak eyes, people's job, people's motivation to perform these operations, having any diseases and taking drugs, the general health of the eye and vision system, the level of vision of people after correction with glasses, the absence of any sensitivity and moderate and severe eye dryness, the health of the eyelids and eyelashes, and detailed information about the advantages and disadvantages and possible problems should be given to the applicants.
Pre-operative examinations
LASIK, LASIK and PRK surgeries and other similar procedures are among the simplest eye surgeries, and more than the surgery itself, careful pre-operative examinations play a major role in achieving success. Therefore, the importance of pre-operative examinations or post-operative care is much more important than performing the operation itself. It has been seen many times that the surgery was done in the best way, but people suffered complications due to lack of skill in pre-operative examinations. Therefore, it is very important to perform pre-operative examinations, especially regarding the accurate determination of the glasses score. Because if the amount of weakness is not determined correctly, the amount of correction may be more than the actual size of the eye weakness or less than the actual size, and the person must wear glasses again after the operation or, if possible, undergo surgery again.
The first stage of pre-operative examinations: taking the history of the applicant for the operation
In this section, comprehensive information on age, sex, level of education, occupation, eye health status from the past to the present, the presence or absence of history such as trauma or infection in the eye, the use or non-use of eye medications, the use or non-use of contact lenses, and the time of the last change in the number Collect glasses. Also, questions about the general health status of the body, the presence or absence of important and chronic diseases such as diabetes and rheumatic diseases, drug use, and drug sensitivity must be answered. In women, the question of pregnancy or breastfeeding should also be added to the above. Searching family records for some important eye diseases such as keratoconus, cataracts, retinal tears, and night blindness will also be very helpful.
The main purpose of gathering the above information is to identify people who are at higher risk for performing such surgeries before performing the operation. For example, the presence of a history of eye herpes warns of the possibility of reactivation of herpes after surgery, or the presence of keratoconus in first-degree relatives increases the likelihood of irregular astigmatism, or the use of certain drugs such as Accutane, which is used to treat facial acne (acne) because it causes dry eyes, increases the chance of complications after LASIK or LASIK.
The second stage of pre-operative examinations: detailed eye examination
Those who want to perform LASIK, LASIK, and PRK surgeries, must patiently go through all the stages of the eye examination. Measuring visual acuity without glasses and with glasses, re-determining the number of glasses accurately without using drops, is the first step. It should be remembered that measuring the number of glasses with so-called computerized devices alone is not enough, and the results of these devices must be retested on the eyes using the manual method. Because the range of measurement errors in so-called computerized devices is very large and relying solely on the results of measurements with these devices can lead to serious complications.
Also, measuring the curvature of the cornea, examining eye movements and checking for the presence or absence of deviation in the eye, measuring the degree of constriction and dilation of the pupils in two conditions of darkness and light, microscopic examination of the eye and examination of different structures of the eye, including the eyelids. The condition of the conjunctiva, cornea, iris, lens, and tear film should be done carefully. By instilling an anesthetic drop in the eye, the intraocular pressure should be measured. At the same time, the humidity and the amount of tears are measured using a special paper. Next, by instilling drops that open the pupil (which temporarily disrupts the vision), check the number of the glasses again. Also, the opening of the pupil allows for a complete examination of the retina to make sure of the presence or absence of retinal lesions. The topography map of the cornea, which is prepared using topography devices, orbiscan, pentacam, pachymetry, and Sirius, provides us with valuable information about the condition of the cornea.
Removing any part of the above examinations deprives us of part of the information about the eye, which, if not paid attention to, will increase the possibility of problems after the operation. For example, failure to measure and pay attention to the condition of the tear film can cause dry eyes after LASIK surgery. Or not paying attention to the size of the pupils can cause night vision problems.
The third stage of pre-operative examinations: Consultation
Taking the history and performing the aforementioned examinations provides the doctor with a complete set of information so that he can specifically discuss its various aspects with the patient. weigh and make judgments and decisions based on it. This section is particularly sensitive and it should be ensured that none of the patient's questions remain unanswered, and all his concerns are taken into account. Stating the facts without exaggerating about the results and possible complications of such surgeries tests the patient's expectations and expectations so that people who have expectations in line with the facts will undergo surgery. At this stage, based on the information obtained, the type and method of surgery, its advantages and problems should be explained to the patient so that he can take the low-risk way. Sometimes at this stage, the patient needs more time to think and make a decision, which should be given to him, and even this consultation session can be repeated again so that the person can make the final decision with ease.
types of weak eye operations
In general, eye score correction operations (LASIK, LASIK, PRK, FemtoLASIK and Smile) are divided into three main categories. The first category is that laser cutting is performed to correct the number of glasses in the depth of the cornea, which includes (LASIK and Femto LASIK) operations. The second category is laser cutting to correct the number of glasses on the surface of the cornea, which includes (PRK, LASIK, and epilasik) and the third category (Smile), which by shining laser rays on the cells between the layers of the cornea, separates a layer and removes this layer through a small hole on the side of the cornea. If the imaging results of the corneal surface and corneal thickness; tear layer of the eye; and the size of the pupil is acceptable; Both LASIK and superficial procedures such as laser (PRK) or LASEK (LASEK) and other procedures can be performed. In terms of accuracy, they all work exactly the same. The amount of post-operative discomfort and pain in laser (PRK) or LASEK (LASEK) will be higher than LASIK, and the recovery period is slightly longer in laser (PRK) or LASEK (LASEK). But the important thing is that in PRK or LASEK, the cornea is manipulated less than in LASIK. Although the probability of complications is small in both methods, this probability will still be less in laser (PRK) or LASEK (LASEK) operation.
If you are among the people who are usually exposed to more shock and trauma, such as military and law enforcement personnel as well as martial arts athletes, performing laser (PRK) or LASEK (LASEK) operation is a more logical decision, because the layer created in LASIK operation can never even regain its previous strength. After years of years.
PRK operation technique
In PRK operation, first the cells covering the surface of the cornea (epithelium) are removed with a special spatula, and then the surface of the cornea is trimmed with an excimer laser according to the eye number, and at the end, a dressing lens is placed on the cornea. It takes about 3 to 5 days for the corneal covering cells to be completely repaired. During these five days, the person should rest at home and refrain from manipulating his eyes. Until the corneal covering cells layer is repaired, the person will have some pain and discomfort, which will disappear over time. In the PRK method, the cornea is manipulated less than other methods. See below the video how PRK works. برای مشاهده روی تصویر کلیک کنید .
تکنیک عمل لیزیک
در عمل لیزیک در ابتدا توسط وسیله ای بنام میکروکراتوم ( شبیه رنده نجاری ولی در ابعاد بسیار بسیار ظریفتر ) یک لایه ( flap ) از قسمت سطحی قرنیه به قطر تقریبی ۹ میلی متر و ضخامت در حدود ۱۶۰ میکرون ( هر میکرون برابر با یک هزارم میلیمتر است ) برداشته می شود . سپس با لیزراکزایمر قسمت مرکزی عمق قرنیه به تناسب نمره ضعیفی چشم تراش داده می شود و در انتها لایه یا flap بجای اولیه خود برگردانده می شود و در جای خود فیکس می گردد .
عمل لیزیک عمل کم عارضه ای میباشد ولی بدون عارضه هم نیست .عوارض عمل لیزیک دو دسته هستند . دسته اول عوارض خفیف و گذرایی هستند که اکثر افرادی که تحت عمل لیزیک قرار می گیرند کم و بیش ممکن است آن را تجربه کنند . مانند افت کیفیت بینایی علی الخصوص در شب ؛ مشکلات دید شب مانند پخش نور و دیدن هاله در اطراف اشیا نورانی ؛ سایه دار دیدن اشیاء ؛ خشکی خفیف چشم ؛ و خونمردگی زیر ملتحمه نام برد . These side effects are not very important because they do not cause serious problems for vision and eyes and they recover within several weeks.
The second side are side effects that are very rare but can cause serious problems for eyes and vision. such as infection; non-infectious inflammation; corneal stain; irregular astigmatism; severe dry eyes; And he mentioned the permanent problems of night vision. Many of these complications can be prevented if sufficient care is taken in the initial examinations and selection of the patient before the operation. In the case of infection and non-infectious inflammation, if treatment is started on time, the consequences will be minimized. فیلم زیر نجوه عمل لیزیک را نشان میدهد .
تکنیک عمل فمتو لیزیک
عمل فمتو لیزیک عمل نسبتا جدیدی محسوب میشود و نسبت به لیزیک عمل بهتر و پیشرفته تری محسوب میگردد . نحوه عمل در روش فمتو تقریبا مشابه عمل لیزیک میباشد با این تفاوت که در عمل لیزیک برداشتن لایه flap بوسیله وسیله ای به نام میکروکراتوم انجام میگردد و لایه ای به ضخامت ۱۶۰ میکرون از سطح قرنیه برداشته میشود ولی در تکنیمک فمتو لیزیک این لایه فلپ بوسیله اشعه لیزر و به صورت خیلی دقیق تر و ضخامت نسبتا کمتر برداشته میشود . The rest of the procedures of Femto LASIK are similar to LASIK and after irradiating the laser beam to the surface of the cornea and trimming the surface of the cornea according to the eye score, the flap layer is returned and fixed. The advantages of Femto compared to LASIK are faster recovery, reduction of visual errors, and less score return. In the video below, you can see how Femto LASIK is performed.
Lasek operation technique
Lasek operation (LASEK) is actually another part of the same laser operation (PRK). In the LASIK operation, the main part of the operation is completely similar to the PRK operation, the only difference is in the method of removing the cells covering the surface of the cornea, with the help of diluted alcohol, these cells are separated from the cornea as a continuous layer, and after cutting with a laser, this cell layer is returned to the surface of the cornea. Here, the creation of this cell layer should not be confused with the creation of a flap in LASIK. In the LASIK operation, a layer with a thickness of about 160 microns is removed, which is much thicker than the cell layer in the LASEK operation.
It is interesting to know that sometimes during the LASEK operation, we lose this cell layer, in which case no major incident occurred and only the LASEK operation has become a laser operation (PRK). But if the same accident happens in the LASIK operation, it means that a layer with a thickness of 160 microns is lost, which certainly cannot be compensated.
About four or five years ago, LASEK operation was considered to have several advantages over PRK operation. But these days, many surgeons consider these two operations to be very similar in terms of results and do not see much difference between them.
In the video below, you can see how Lasak is performed. برای مشاهده روی تصویر کلیک کنید .
تکنیک عمل اسمایل ( smile )
تکنیک جراحی اسمایل برای اصلاح نمره عینک در حال حاضر جدیدترین و پیشرفته ترین نوع عمل اصلاح عیبوب انکساری میباشد .در این روش برخلاف روش های دیگر از هیچ وسیله مکانیکی برای انجام برش های قرنیه ای و و برداشتن فلپ استفاده نمیشود و تمامی مراحل عمل از صفر تا صد توسط لیزرهای بسیار دقیق انجام میگردد . در این روش با توجه به مقدار ضعیفی چشم و بدون دستکاری کردن سلولهای پوششی سطح قرنیه و بدون برداشتن فلپ از سطح قرنیه اشعه لیزر را به عمق ۱۱۰ تا ۱۳۰ میکرون از عمق میانی قرنیه می تابانند ویک لایه نازک به شکل یک عدسی کوچک از بین لایه های میانی قرنیه جدا میکنند و سپس با استفاده از لیزر فمتو سکند یک برش ۲ میلی متری در کنار قرنیه ایجاد میکنند و با وسیله مخصوصی لایه جدا شده عدسی مانند را از محل برش میلی متری از میان قرنیه خارج میکنند و به این وسیله ضعیفی چشم را اصلاح میکنند . In the Femto Smile method, unlike other methods such as LASIK or Femto LASIK, which create a 20 mm incision to create a flap, only a 2 mm incision is made, so the sensory nerves of the cornea are almost less disturbed than in other methods, and on the other hand, considering that in this method, no manipulation or removal of the cell layer is performed on the surface of the cornea, and the removal of the cell layer and irradiation of the laser beam are all done in the depth of the middle layers of the cornea, so after the operation, disorders are caused. Tears, dry eyes, eye irritation and vision errors are far less common than other methods. Also, this method is more reliable for high scores and relatively thin corneas. In the video below, you can see how to perform Femto Smile.
