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Corneal refractive surgery
Miltos Balidis PhD, FEBOphth, ICOphth
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Symposium of the Hellenic Society of Intraocular Implant and Refractive Surgery
Cairo, 14/3/2018
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• Professional standards for refractive
surgery
• Long term results
• Ectasia
• Out of the box
• Considerations
EOS 2018
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Long-term results of superficial laser in situ keratomileusis after ultrathin flap creation
George D. Kymionis, MD, PhD, Nikolaos Tsiklis, MD, Aristofanis I. Pallikaris, PhD, Vassilios Diakonis, MD, George Hatzithanasis, MD,
Dimitra Kavroulaki, MD, Mirko Jankov, MD, Ioannis G. Pallikaris, MD, PhD
Journal of Cataract & Refractive Surgery
Volume 32, Issue 8, Pages 1276-1280 (August 2006) DOI: 10.1016/j.jcrs.2006.02.054
www.ophthalmica.grJournal of Cataract & Refractive Surgery 2006 32, 1276-1280DOI: (10.1016/j.jcrs.2006.02.054) Copyright © 2006 ASCRS and ESCRS
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www.ophthalmica.grJournal of Cataract & Refractive Surgery 2006 32, 1276-1280DOI: (10.1016/j.jcrs.2006.02.054) Copyright © 2006 ASCRS and
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Long-term results of laser in situ keratomileusis for high myopia: Risk for ectasia
Patrick I. Condon, MCh, FRCS, FRCOphth, Michael O'Keefe, MCh, FRCS, FRCOphth, Perry S. Binder, MD
Journal of Cataract & Refractive Surgery
Volume 33, Issue 4, Pages 583-590 (April 2007) DOI: 10.1016/j.jcrs.2006.12.015
Copyright © 2007 ASCRS and
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www.ophthalmica.grJournal of Cataract & Refractive Surgery 2007 33, 583-590DOI: (10.1016/j.jcrs.2006.12.015) Copyright © 2007 ASCRS and ESCRS
UCVA 5-7 years
www.ophthalmica.grJournal of Cataract & Refractive Surgery 2007 33, 583-590DOI: (10.1016/j.jcrs.2006.12.015) Copyright © 2007 ASCRS and
BCVA 5-7 years
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Figure 6
Journal of Cataract & Refractive Surgery 2007 33, 583-590DOI: (10.1016/j.jcrs.2006.12.015) Copyright © 2007 ASCRS and ESCRS
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Risk Assessment for Ectasia after Corneal Refractive Surgery
J. Bradley Randleman, MD, Maria Woodward, MD, Michael J. Lynn, MS, R. Doyle Stulting, MD, PhD
Ophthalmology
Volume 115, Issue 1, Pages 37-50.e4 (January 2008) DOI: 10.1016/j.ophtha.2007.03.073
Copyright © 2008 American Academy of Ophthalmology Terms and Conditions
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www.ophthalmica.grOphthalmology 2008 115, 37-50.e4DOI: (10.1016/j.ophtha.2007.03.073) Copyright © 2008 American Academy of
www.ophthalmica.grOphthalmology 2008 115, 37-50.e4DOI: (10.1016/j.ophtha.2007.03.073) Copyright © 2008 American Academy of Ophthalmology Terms and Conditions
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Figure 11
Ophthalmology 2008 115, 37-50.e4DOI: (10.1016/j.ophtha.2007.03.073) Copyright © 2008 American Academy of Ophthalmology Terms and Conditions
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PTA
EOS 2018
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LVA Only option
• Scars
• Post viral subepithelial infiltrates
• Basement membrane or anterior
stromal dystrophies
EOS 2018
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Combined PTK / PRK
• OCT for scars
• PTK with viscoelastic masking
• Treat the underline cause
• Treat the preexisted or induced
refractive error
EOS 2018
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Refraction
Transparencyirregularity
EOS 2018
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• Hyperopic shift after PTK
– Laser physics
– Biomechanics
– Biological response
• Smoothening of surface
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• Solution
– 20μm PTK 1 D hyperopic treatment
– 40μm PTK and masking 1 d hyperopic
treatment
– Peripheral CXL?
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LVA not an option
• Advanced presbyopia?
• Younger than 18 years?
• Autoimmune disease?
• OSD?
EOS 2018
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A good candidate for LASIK must be at
least 18 years of age, have a stable
refraction and healthy corneas
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RLE is not an option
• Younger than 50
• Low myopes
• High astigmats
• Picky patient
EOS 2018
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