FEMTO LASIK Blade less removal of glasses A Dream comes True Overview and surgical video is presented.

1. • Dr. Zia-Ul-Mazhry
• FCPS(Pak), FRCS(Edin),
• FRCS(Glasgow),CICOphth- (UK)
• Associate Professor Central Park Medical CollegeConsultant
Eye Surgeon & Head of Deptt
WAPDATeaching Hospital Complex
• Visiting ConsultantAcuity Eye Center
• Lahore Pakistan

2. The Journey Begins
FEMTO LASIK
Blade less removal of
glasses

3. ESCRS 2011Vienna Austria
Hands on Femto LASER experience on Artificial Eyes

4. WOC 2013Tokyo Japan
Hands on FEMTOLASER experience on Pig Eyes

5. LMC Lahore 2014
First Acuity Eye Center Patient gets FEMTO LASIK by Dr. Mazhry

6. FEMTO LASIK
Blade less removal of glasses
A Dream comes True

7. Zeimer FEMTO-LDV
Femto-LASIK
The MEL80 from Carl Zeiss Meditec.

8. Femto second Laser
• Femto second Laser employs near- infrared pulses to cut tissue with minimal
collateral tissue damage (mode-locked, diode pump, neodymium- glass laser)
• Infrared wavelength range, at 1053 nm
• It uses a spot size of less than 3 micron
• Produces tissue disruption at a specified and precise level within the corneal
stroma
• Femto second has different applications in ophthalmology
• Its major use at present is cutting flap in LASIK surgery

9. Femto LASIK
Flap creation
• The depth of the flap is
typically set at 100±10
micron
• Studies have shown that the
standard deviation of flap
thickness is around 14.
• The flap diameter is typically
set to about 9.0mm.

10. Femto LASIK
Major advantage
femto second over
microkeratome
• Flap criteria
• Accuracy of flap thickness
• Refractive outcome
• Capability and choice of -Cutting thin flap (90 µm)
-Different diameter,
-Hinge position
-Hinge length
• Safety and predictability
• Absence of moving parts
• ↓Complications
• Improved staff and physician satisfaction

11. Femto LASIK
Possible Advantages
•Fewer higher order aberrations
• Less astigmatism
• Better contrast sensitivity
• Less epithelial ingrowth
• Lower enhancement rate
• Less dry eye

12. Femto LASIK
Disadvantages
• High price
• Large physical size
• Lack of portability
• Speed and the time needed to prepare the flap

13. Femto Lasik
• Surgical technique and operation
-Pre operation evaluations
-During operation
-After operation

14. Femto LASIK
Surgical technique
• Pre-op evaluation
-Patient selection
-Machine preparation
-depth
-size
-hinge

15. Femto LASIK
Surgical technique
• During operation
-Patient's position
-Hand piece position
-Centering
-Suction (enough IOP)
-Laser

16. Femto LASIK
Surgical technique
• After operation
-edge release
-lifting of the flap
-ablation
-repositioning of the flap

17. Femto LASIK
Surgical technique
• Special points
-Suction release and re cut
-Bridges
-Gas bubbles
-IOP
-Duration

18. Femto LASIK
Surgical technique
• Gas bubbles
-interface →Opaque media
-rare →deep stroma → tracker
-rare → subepithelial loss of vacuum
Button hole
-rare → Between cornea and hand piece
-rare → in A/C

19. Femto LASIK
Complications
• Absence of usual complications
-Buttonhole
-Small flap
-Free caps
-Irregular cut

20. Femto LASIK
Complications
• Suction breaks
• Incomplete flaps
• Thin flaps, tears
• Increased postoperative inflammation
• Persistent bubbles
• Decentered flaps
• Slipped flaps

21. Femto LASIK
Special complications
• TLSS (transient light sensitivity syndrome)
• Gas bubble
• DLK (lamellar inflammation)
• Glare

22. Femto LASIK
TLSS
• Occur days to weeks after femto second
• Extreme photophobia
• GoodV.A
• Absence of clinical findings
• Response of keratocyte
• Inflammatory response to surrounding tissue to gas bubble
• Topical corticosteroid

23. Femto LASIK Movie