corneal surface with a femtosecond laser of
20-23mm with the retaining hinge of 5mm. The
corrective Excimer Laser process is applied to
the bed of the lifted flap to make the refractive
correction and the flap is then returned to take up
the new shape of the cornea.
The pressure on refractive surgery to join the
incision size change has lead to a reduction in
the 20-23mm incision to a mere 3mm incision!
The catch phrase for this new technology is
“SmILE” or Small Incision Lenticule Extraction.
This wonderful new procedure, driven by the
availability of the femtosecond laser technology,
allows the “SmILE” process to be done by
cutting the whole visual correction within the
corneal substance in the inert central cornea and
by removing the redundant tissue through the
3mm hole in the corneal periphery.
Almost all forms of short sightedness and
astigmatism can be treated this way, and again
because of the incision size falling into the “Small”
category as mentioned above, the recovery time
is short, stability high and resilience excellent,
especially for those involved in sport and in
particular, contact sports and similar occupations.
One of the procedures that falls into the
treatment category rather than the refractive
category but is nevertheless improving vision
and lessening spectacle dependence is the
insertion of Intra-Stromal Corneal Ring Segments
(ICSRS), the most commonly used of which
are Kerarings. Kerarings are used to regularise
the distorted corneas of keratoconus and some
corneal grafts. Keratoconus is a corneal softening
disorder that occurs mainly in young people that
can cause poor vision. The first procedure that
is done to treat this condition is called Corneal
Collagen Crosslinking. This procedure stabilises
the soft cornea, stopping or at least slowing the
corneal distortion process. The distortion from
keratoconus (for those people who are contact
lens intolerant) can be further improved by
inserting kerarings into the corneal mid stroma,
regularising the distorted areas and improving
vision. The tracks that guide the kerarings into
the correct position are made by the femtosecond
laser discussed above. The access point into
the cornea, cut by the femtosecond laser is only
1.5mm wide, another of the wonderful micro-incisional
procedures.
WHAT ABOUT GLAUCOMA?
We have heard about procedures managing
Glaucoma in earlier articles in this magazine.
These procedures are fulfilling the mantra
under discussion of incisional size reduction
(and in this instance, simultaneous reduction in
surgical invasiveness).
The term being used for the insertion of the
new devices controlling glaucoma is much
like the cataract term used above (“MICS”)
but is “MIGS”! The term currently has two
interpretations - either Minimally Invasive
Glaucoma Surgery or Micro-Invasive Glaucoma
Surgery. Either way the connotation is there,
explaining that the actual intervention is small
but with good effect. What a revelation it is
for patients to have a small surgical procedure
with great effect in the majority, allowing
them in many instances to dispense with (or
at least reduce the burden of) daily eye drop
administration, planned for the rest of their lives.
These examples go on further in other aspects
of Ophthalmology as well.
So, roll on technology, keep up the good work
in helping the doctors help the patients!
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