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Eye Care

EYE CARE

 A.  CATARACT SURGERY

  1. Phacoemulsification with IOL (Flexible Lens)
  2. YAG laser capsulotomy

B.  REFRACTIVE CORRECTION SURGERY

     1.   Refractive Laser (Excimer) Refractive Non-Laser

    1. LASIK
    2. LASEK
    3. PRK
    4. EpiLASIK
    5. All Laser LASIK (with Femtosecond Laser)

     2.    Refractive Non-Laser

                  a.     Conductive Keratoplasty

C.  COSMETIC SURGERY OF THE EYELID

  1. Routine Pterygium Removal 
  2. Ectropion Correction
  3. Entropion Correction
  4. Ptosis Correction – 1 Upper Eyelid

D.  EYE MUSCLE CORRECTION SURGERY

  1. Eye Muscle correction (squint/strabismus)

E.  CORNEA

  1. Corneal transplantation (penetrating keratoplasty)

F.  GLAUCOMA

  1. Trabeculectomy filtering
  2. Drainage valve devices implantation
  3. YAG laser iridotomy
  4. Cyclodiode photocoagulation
  5. Argon laser trabeculoplasty
  6. Argon laser iridoplasty

G.  RETINA

  1. Pars plana vitrectomy
  2. Retinal reattachment
  3. Retinal laser surgery
  4. Transpupillary thermal therapy
  5. Photodynamic therapy
  6. Intravitreal injections

A.  CATARACT EXTRACTION SURGERY

1.  Phacoemulsification with IOL

A cataract is a clouding in the lens of the eye. This cloudiness can cause  blurred vision, diminished vision at night, dimness of color vision and frequent prescription changes.  Often cataracts cause no problems for many years but as the cataracts mature, the cloudiness increases on the lens and the light reaching the retina decreases; significant sight loss and perhaps blindness can result. The development of cataracts is related to aging, poor nutrition, ultraviolet sunlight, smoking, systemic diseases, eye trauma and certain medications, such as steroids.  

Cataract extraction is an outpatient procedure and has 3 major steps: making the microscopic incision, phacoemulsification and implanting of the flexible lens.  After application of a local anesthesia, the surgeon makes a very tiny incision on the cornea, the clear, dome-shaped surface that covers the front of the eye.  He then widens the slit to form a circular opening for the phacoemulsification probe which emits ultrasound waves to soften and break up the cataract into smaller fragments so it can be removed by suction.   The intraocular lens is then placed in the area where the natural lens was just removed from.

    After procedure

    Some patients may be asked to wear a shield over the eye, particularly while sleeping.  One should not rub or put pressure on the eye.  There may be sensitivity to light, eye redness and blurred vision.  Often, patients will have watery eyes.  All of these symptoms will disappear within a few days following the procedure.  A great majority of patients may resume normal activities on the day of or day after surgery. 

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2.  YAG Laser Capsulotomy

Following cataract surgery, about 20% of patients will develop haze of a membrane behind the intraocular lens (IOL) implant which results in diminished vision. It may be blurred, hazy, or is associated with significant glare and loss of visual acuity. This condition, known as posterior capsule opacity, is sometimes referred to as “secondary cataract.” Cataracts, however, never recur following cataract surgery. 

Posterior capsule opacity may be thought of as a scarring process in the capsule or membrane, which contained the natural lens (cataract) of the eye. The condition of posterior capsule opacity is not preventable, but fortunately, is treatable and nearly always restores or improves vision.

Posterior capsule opacity may be treated with an outpatient minor laser procedure known as a YAG laser capsulotomy. In this procedure, a laser is used to remove the hazy capsule found behind the IOL implant. This usually requires dilation of the eye prior to the procedure. The procedure takes only a few minutes, is entirely painless, and is not associated with any post-operative discomfort.  Anti-inflammatory eye drops are usually recommended following the procedure.

After procedure

Following a YAG laser capsulotomy procedure, patients may resume normal activities immediately.  Most patients may expect their vision to improve a day following the procedure. As with any eye procedure, patients should contact their doctor immediately if visual acuity worsens or fails to improve. Patients should anticipate some “floaters” following this procedure, however, these will likely resolve within a few weeks time. 

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B. REFRACTIVE CORRECTION SURGERY

Refractive Laser (Excimer)

1.  LASIK

LASIK stands for Laser Assisted In Situ Keratomileusis. In bilateral eye vision correction by LASIK surgery, precise and controlled removal of corneal tissue by a special Excimer laser and Keratome reshapes the cornea changing its focusing power. A wavefront card is used to make the reshaping finer and smoother resulting in lesser tissue ablation and better final functional vision.

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2.  LASEK

LASEK stands for Laser Epithelial Keratomileusis. Also called epithelial LASIK or E-LASIK, LASEK is used mostly for people with corneas that are too thin or too flat for LASIK. It was developed to reduce the chance of complications that occur when the flap created during LASIK is not the ideal thickness or diameter.

In LASEK, the epithelium, or outer layer of the cornea, is cut not with the microkeratome cutting tool used in LASIK, but with a finer blade called a trephine. Then the surgeon covers the eye with an alcohol solution for around 30 seconds. The solution loosens the edges of the epithelium.

After sponging the alcohol solution from the eye, the surgeon uses a tiny hoe to lift the edge of the epithelial flap and gently fold it back out of the way. Then he uses an excimer laser, as in LASIK or PRK, to sculpt the corneal tissue underneath. Afterward, the epithelial flap is placed back on the eye with a kind of spatula.

After LASEK

In many ways, what you can expect from LASEK is similar to what you can expect from LASIK, but there are some differences. According to doctors who perform LASEK, the flap edge heals in about a day, though patients usually wear a bandage contact lens for around four days. You may feel eye irritation during the first day or two afterward. Also, the time it takes to recover good vision is often longer — up to four to seven days.

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3.  PRK

Photorefractive keratectomy (PRK) is a procedure in which the surface of the cornea is reshaped by an ophthalmologist using an Excimer laser. PRK may be used to treat myopia (nearsightedness), hyperopia (farsightedness), or astigmatism. PRK does not involve creation of a corneal flap utilizing the microkeratome, and therefore, the protective superficial layers of the cornea must heal post-operatively. This generally means that patients who undergo PRK will require significantly more time than LASIK patients to achieve their best vision. 

A few minutes prior to the PRK procedure, anesthetic drops will be applied to the eye to numb the eye and prevent pain during the procedure. A speculum will be placed to hold the lids apart for the procedure, eliminating any concern that blinking during the procedure would present a problem. The eye surgeon will then gently remove the surface corneal cells (epithelium) and proceed with the laser aspect of the procedure. The laser, being computer driven for accuracy and precision, is programmed based on the patient’s refractive error (nearsightedness, farsightedness, astigmatism). 

The laser delivery takes less than one minute for most patients. Once the refractive ablation is completed, i.e., the corneal curvature is reshaped, the surgeon will place a bandage contact lens on the eye for improved comfort along with anti-inflammatory and antibiotic eye drops. The patient can usually leave the laser center within a few minutes following the procedure.

After Surgery

Immediately after the procedure, a bandage contact lens will usually be applied to the eye. This contact lens is worn for the first 2 to 3 days until the surface epithelium is healed. When the surface epithelium is healed, the eye will be comfortable, and the bandage contact lens is removed. Eye drops are required to prevent infection and control inflammation following surgery. Your vision will gradually improve. Generally, vision will be good enough to drive a car within two to three weeks following surgery, but your best vision may not be obtained for up to 6 weeks to 6 months following surgery.

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