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Femto-Lasik or Z-Lasik is the most efficienttechnology currently available within thefield of laser eye surgery. Lasik stands for‘laser-assisted in situ keratomileusis’ – themethod involved in this type of procedure.Femto represents the technology, in thiscase the most recent type of laser: theFemtosecond.The Femtosecond laser method involvesthe cutting of a microscopically thin flap onthe surface of the cornea, after which theExcimer laser is used to correct anyexisting refractive errors. With Femto-Lasik,we can easily and successfully treat eyedioptre prescriptions between -12 and 6.Say a rapid farewell to your glasses, makea no-strings attached appointment today. ahref "http://www.vimeo.com/36132179" http://www.vimeo.com/36132179 /a

The Focus Eye Clinic uses the WavelightEX500 Excimer laser and the Ziemer Z8Femto laser. Both of these devices areconsidered state-of-the-art.The combination of both of these devicesguarantees predictable and reliable resultsand extreme precision using a quick,painless and safe technique.Advantages of Femto-Lasik1. Optimal safety :Highly reduced risk of complicationswhen cutting the corneal flap.Reduced risk of infection andinflammationLarger treatable surface for increasedstabilityReduction in retreatment rates2. Thinner flap:The Femto-Lasik allows for such a thin,uniformly cut corneal flap that

complications are practically nonexistent. With these thinner flaps, morecorneal tissue is left behind, meaningnot only an increase in long-termcorneal stability, but also theopportunity to correct higher refractiveerrors.3. Even flap thickness:When using the Femto-Lasik, thesurgeon knows beforehand whichform, thickness, measurements andcapacity each flap entails. This is animportant issue when consideringtreatment for higher refractive errors.When using a scalpel, a surgeon canonly know how the flap will look afterthe cut has been made.4. Other benefits:Eyeball measurements are of littleimportance for Femto-Lasik laser eyesurgery.You will heal in a shorter span of time

and your sight will improve much morequickly.Visual results are excellent.During the procedure, the Femto-Lasiklaser exercises less pressure on theeye. This means the patient willexperience very little discomfort.Will Femto-Lasik work for me?Nearly everyone with nearsightedness(myopia), farsightedness (hypermetropia)or astigmatism can be treated using theFemto-Lasik method.You are between 18 and 60 years oldYou are in good healthRefractive errors between -12 and 6Refractive errors have not undergone anychanges during the past year

People who suffer from very dry eyes orhave thin corneas are often not consideredfor Femto-Lasik surgery. They would bebetter served using the alternative butexcellent PRK method.For age related vision problems, otherwiseknown as presbyopia, Femto-Lasik is notthe ideal solution. We would recommendmultifocal lens implants.Treatment should be postponed duringpregnancy or when breast feeding. We willnot carry out Femto-Lasik procedures onpatients with the following pathologies: viraleye infections, herpes, diabetes mellitus,keratoconus and any pathologies requiringcortisone therapy.Still not sure? Come and have a chat. Makeyour obligation-free appointment today.Femto-Lasik pricing

Focus Eye Clinic puts transparent pricinginto practice. You pay the advertised pricefor Femto-Lasik treatment using the latesttechnology.Treatment for one eye costs 1,750. Botheyes will cost 3,250. A no-strings pretreatment consultation with one of oursurgeons is completely free.Femto-Lasik: practicalinformationThe entire Femto-Lasik procedure ascarried out at the Focus Eye Clinic – fromarrival to discharge – takes approximately 2hours.Before the procedureOn the day of your Femto-Lasik procedurewe will repeat all preoperative

measurements. You will then be given alight sedative. Your eyes will beanesthetised with a local anaesthetic.There is therefore no need for a fullanaesthetic.During the procedureNursing staff will help you onto theoperating table situated within the FemtoLasik treatment room.They will thoroughly disinfect youranesthetised eyes and cover them with asterile dressing. Your eyelashes will bemoved aside and your eyes once againanesthetised using a local anaesthetic. Aneyelid holder will be put into place, makingit impossible for you to blink or close youreyes.Cutting the corneal flap takes just 26seconds using a device placed directly ontothe eye. It is via this device that the Femto

Laser forms the flap. Don’t worry: nothingyou do can change the position of or adjustthis device.After the flap has been formed the surgeonuses the Wavelight-Excimer laser to treatthe refractive error. For this, you will needto look into a fixation light for 1 second;after you have done this the laser willautomatically follow the movements of youreye.Finally, the flap is put back, thoroughlyrinsed and pressed into place.After the procedureYou will be taken to a rest and relaxationarea where you will stay for approximately30 minutes. On the day of the procedureitself you should not drive. Please bringsomeone with you! We do not recommendyour using public transport systems.Postoperative medication consists of eye

drops. You will also receive protectiveglasses which you are required to wear forthe following 24 hours.AftercareYou will come for a control visit one day,one week and two to three months after theprocedure. These visits are included in thelisted price.What risks?Femto-Lasik laser eye surgery is safer thandaily contact lens use. Currently, the mostapplicable risk is that of Femto-Lasikretreatment. However, the chance of thisoccurring is less than 0.5%.As in all types of surgery there is a limitedrisk of infection and inflammation. You willreceive eye drops and protective glasses toreduce such risk.

Older techniques could sometimes lead topermanent dry eyes. The state-of-the-artFemto-Lasik method, together withsufficient preoperative care, has drasticallyreduced this risk. Any temporary decreasein tear production can be treated withlubricating eye drops and tear duct(lacrimal) plugs.There is no risk of decreased night vision.In fact, the opposite is true; laser treatmentincreases contrast in low light conditions.FAQWhat is an Excimer laser?With the Excimer laser, thin layers of thecornea are evaporated by way of photoablation.This makes it possible to:

change the corneal profileflatten the cornea in cases ofnearsightednessmake the cornea more rounded in cases offarsightednesseven out the cornea in cases ofastigmatismThe newest computer technology cancalculate the correct corneal profileautomatically, as well as the correct dosesof photo ablation. The Wavelight EX500Excimer laser uses “Perfect PulseTechnology” to guarantee both safety andprecision. The 6-sigma tracking systemfollows all eye movement during theprocedure.Reliability and predictability are guaranteedby way of high resolution calibration foreach procedure. Aspheric laser ablationmeans improved night vision.

How does the Femto-Lasik laserwork?The Ziemer Z8 Femto laser works using theprinciple of photo disruption: using infraredlaser energy, the surgeon creates a patternof tiny, overlapping spaces immediatelyunder the surface of the cornea. The laseroperates at extremely high speeds:impulses of 1 quadrillionth of a second, or 1femtosecond.These highly accurate laser impulses splitthe corneal tissue at a molecular levelwithout creating heat or touching thesurrounding tissue. As the laser moves upand down across the eye a completecorneal flap is formed. After the flap hasbeen created the surgeon lifts it with aspecially designed instrument. The Excimerlaser is then used to shave away thin slicesof the cornea and in doing so correctrefractive errors. Finally, the surgeon setsthe flap back into place.

What are the Femto-Lasik-options:A-Cat, T-Cat and Lasik-Extra?A-Cat: Femto-Lasik with aberrometryWe now possess sophisticated diagnosticdevices which can register extremely subtlerefractive errors. These aberrations are sotiny that glasses or contact lenses cannothelp. Treatment of specific aberrations (theA-Cat option) can offer more night visioncontrast to those people with widenedpupils. The surgeon will discuss this optionwith you should he consider it applicable.T-Cat: Femto-Lasik with topographyA cornea is usually regular in form(spherical and toric). For some patients,such as those with keratoconus,asymmetrical or irregular astigmatism canonly be seen when using topographicalimaging. If the surgeon thinks you are a

candidate for topography, he will tell youabout the T-Cat option.Lasik-Extra: AvedroWhen using Femto-Lasik therapy forhypermetropia and presbyopia, vision canstart to decline within a few years. Untilrecently, this meant retreatment.Thanks to the Avedro UV Crosslinkingtechnique, retreatment is no longernecessary. With this technique, we treat theeye after the Lasik procedure with UV lightto encourage the attachment of collagenfibres onto the cornea. This means that thenew corneal form will be stable.

Refrakční chirurgie Photorefractive KeratectomyPhotorefractive keratectomy (PRK) is one of the refractive procedures using excimer laser toablate the cornea. It corrects myopia, hypermetropia, presbyopia, and astigmatism. In myopia,the central corneal stroma is ablated to flatten it; in hypermetropia and presbyopia the corneais made steeper by ablating the desired zone. TechniqueUnder topical anesthesia the epithelium is debrided. The patient fixates at the target in themicroscope. The desired amount of corneal tissue is ablated using the nomogram made withthe patient’s data. The eye is taped following the procedure or a contact lens is placed.Postoperative medications include antiinflammatory and lubricating drops. Selected Complications of Photorefractive KeratectomyDecentered AblationD ecentration of the ablation zone by 1 mm or more occurs due to improper patient fixation,centration, or eye movement during the procedure. PresentationPatients present with decreased visual acuity, diplopia, glare, halos, induced astigmatism . ManagementSome decentrations will lessen with time and remolding. Those that do not improve requirecorneal topographic studies. Visual symptom improvement may be attempted with weakmiotics, contact lens, or re-treatment.Central IslandsA portion of the central corneal tissue is raised, leading to area of higher central cornealrefractive power surrounded by an adjacent area of paracentral stroma. It has an elevation ofat least 1 diopter with a diameter of more than 1 mm as compared with the paracentral flatarea. It is seen less often now with the increasing use of flying spot laser systems. PresentationPatients present with visual distortion, double vision, decreased vision.518

ManagementManagement consists of waiting and watching and corneal topographic study. Retreatmentwith the excimer laser may be helpful in selected cases.Disabling Glare or Halos PresentationS ome patients complain of glare and halos around light, especially in scotopic conditions.These symptoms are more pronounced with smaller ablation zones. They may also be seenwith decentered ablations, epithelial ingrowths, and corneal haze. ManagementM anagement consists of constricting the pupil using miotics, topical brimonidine, andsecondary ablation with increasing diameter.Delayed Epithelial Healing PresentationN onhealing epithelium even after 3 to 4 days postoperatively is commonly due to a large areaof debridement, severe dry eye and prophylactic antibiotic and antiinflammatory eye drops,diabetes mellitus, and other autoimmune disorders. Patients present with watering,discomfort, redness, pain, and photophobia. ManagementManagement consists of contact lens wear until reepithelialization, liberal use of lubricatingdrops, and treatment of the underlying cause. Excess nonsteroidal antiinflammatory drugs andcorticosteroids should not be used. The patient may be followed up daily until healing.Infectious KeratitisInfectious keratitis is unusual, with bacterial causes most common. The inflammation typicallycauses redness of the eye with a focal infiltrate. Management includes culturing and antibioticuse directed towards the suspected organism until culture results are known.Haze and Regression PresentationThe healing process of activated keratocytes laying down new collagen fibers leads to cornealhaze. The higher the correction the greater the risk of haze developing. Maximum haze isnoticed between 1 and 3 months postoperatively and decreases with time. Corneal steepeningleads to regression due to the changes in refractive power of the cornea.

ManagementT opical steroids reduce the incidence of haze and regression. Patients having decreased visualacuity may benefit from re-treatment. Laser In Situ KeratomileusisL aser in situ keratomileusis (LASIK) is keratorefractive surgery for the treatment of highmyopia, hyperopia, and astigmatism. TechniqueA corneal flap is created by corneal lamellar incision using a microkeratome or thefemtosecond laser. The flap is then reflected and the corneal stroma is reshaped using theexcimer laser. The flap is repositioned and realigned correctly after the procedure and allowedto adhere back on its own. It is used in the healing process. Visual recovery is quicker, with lessscarring and regression compared with PRK because the epithelial surface is not debrided andthe Bowman layer is not ablated. Selected Complications of Laser In Situ KeratomileusisDebris after LASIK PresentationI nterface debris is common and often results from meibomian gland secretions or makeup ormascara. These are typically not visually significant unless they occupy a large area and createan interface scar.To prevent debris, it is important to operate in a lint-free environment, use nonfragmentingsponges, and have patients clean their lids well before surgery to remove all makeup andmascara (Fig. 19.1). ManagementNo intervention is needed unless enough debris is present that it is at risk of forming aninterface scar or the debris degrades the vision.Flap Striae PresentationThe patient with flap striae may have monocular diplopia due to irregular astigmatism in thepresence of microstriae. It may be a result of mild or significant LASIK flap displacement (Fig.19.2).

ABFig. 19.1 (A) Mascara in theinterface after LASIK. (B) Moderatemascara in the interface. This istypically not visually significant. (C)Metal flecks in the interface, which istypically not reactive or visuallyCsignificant.

ABFig. 19.2 (A) Striae across the visual axis from a displaced flap. (B) Peripheral striae thatare not always visually significant, yet can occasionally cause induced asymmetricastigmatism. (Continued on page 524)CDFig. 19.2 (Continued) (C) Significant striae in the visual axis. (D) Severe striae frombunching of the flap. PreventionA lignment of the created trough by even placement of the corneal cap over the stromaevenly in all directions can help reduce the incidence of striae. Some surgeons advocatemaking a mark on the epithelium prior to creation of the flap to help with postoperativealignment, yet care must be taken that the epithelium does not shift in relationship tothe stroma when using these marks to realign the flap.

ManagementMicrostriae may be observed if not visually significant. If they are visually significant,the surgeon may need to lift the flap, clean the interface from any cells or debris, andstretch the cap by stroking it with Merocel wipes (Medtronic, Minneapolis, MNwww.medtronicophthalmics.com/Ophthalmics Catalog 2007 2008 LR.pdf) until thegutter is well aligned.Diffuse Lamellar KeratitisDiffuse lamellar keratitis (DLK) is a sterile inflammation of the flap interface occurring inthe first week after LASIK. The condition has also been known as “shifting sands”phenomenon or “sands of the Sahara.” PresentationSevere DLK may occur in 1 out of 5000 cases, and mild DLK in 1 in 50 cases in mostcenters. Stage 1 : Defined by the presence of white granular cells in the periphery of the lamellarflap, outside the visual axis (Fig. 19.3 ). Stage 2: Defined by migration of cells in the center of the flap, involving the visualaxis, in the flap periphery, or in both. It is more frequently seen on day 2 or 3. Theresult of central migration of cells in stage 1 gives the so-called shifting sandsappearance. This occurs in 1 in 200 cases (Fig. 19.4). Stage 3: The aggregation of more dense, white, and clumped cells in the central visualaxis, with relative clearing in the periphery. This is often, but not always, associatedwith a subtle decline in visual acuity by 1 or 2 lines and a subjective description of hazeby the patient. The frequency of stage 3 may be as high as 1 in 500 cases (Fig. 19.5).ABFig. 19.3 (A) Stage 1 diffuse lamellar keratitis (DLK) with mild cell in the peripheral flap.(B) Stage 1 DLK with mild cell in the peripheral flap—high magnification.

AFig. 19.4 (A) Stage 2 diffuse lamellar keratitis (DLK) with cells in the periphery andcentral portion of the flap. No significant clumping of the cells is seen in stage 2. (B)Stage 2 DLK—high magnification.Fig. 19.5 Stage 3 diffuse lamellarkeratitis with cells that are nowaggregating, typically slightly below thecenter of the visual axis.B

ABCFig. 19.6 (A) Stage 4 diffuse lamellar keratitis (DLK) with stromal melting. (B) Stage 4DLK. (C) Stage 4 DLK with irregular astigmatism with flattening due to tissue loss wherethe cells had aggregated, typically slightly below the visual axis. Stage 4 : The presence of stromal melting, often associated with permanent scarringand visual morbidity. There is fluid collection in the central lamellae with bullae

formation and stromal volume loss. A hyperopic shift occurs due to central tissueloss, along with the appearance of corrugated “mud cracks,” which are a seriousfinding. The incidence is 1 in 5000 cases (Fig. 19.6).Fig. 19.7 Lifting and gentle irrigation of the flap is idealmanagement for stage 3 diffuse lamellar keratitis (DLK), typically atday 3 or day 4 after the surgery. Management Stages 1 and 2: Topical prednisolone acetate 1% every hour and steroid ointment(fluoromethalone) at bedtime. Follow up in 24 to 48 hours. Stage 3 : Lifting the flap, debulking the inflammatory reaction by careful irrigation of the bedand undersurface of the cap. It is usually done on day 3 or 4 after the procedure (Fig. 19.7). Stage 4 : No definitive successful treatment identified. If white cells are still present, thengentle irrigation may be helpful in reducing tissue necrosis. Otherwise, waiting for epithelialhyperplasia may allow improvement in irregular astigmatism. Rigid gas-permeable contactlenses are often helpful for visual rehabilitation. Wavefront-directed surface treatment withmitomycin C can be considered after full epithelial hyperplasia has occurred, usually at 1year postoperatively.Epithelial IngrowthG rowth of epithelium into the interface between the flap and the stroma results in irregularastigmatism and loss of best corrected visual acuity. The presence of the epithelial cells in theinterface can be safely followed without intervention in the majority of cases. The epithelial

cells in the interface can block the supply of nutrients to the underlying stroma and result innecrosis of the flap, extrusion of the

similar to LASEK. But instead of using alcohol to loosen the epithelium like in LASEK, in epi-LASEK the surgeon typically uses a blunt, plastic blade to separate the epithelial sheet from the eye. This avoids the possibility of a reaction from the alcohol, which can kill epithelial cells. LASIK, PRK and