IntraLase: Creating a LASIK Flap with Precision
A new technology called IntraLase seems to enhance the safety of LASIK vision correction using laser energy rather than a microkeratome, a cutting tool with a metal blade used in traditional LASIK procedures.
In LASIK, the microkeratome is used to cut a hinged flap in the cornea. The flap is folded back, and an excimer laser is used to remove (or “ablative”), some tissues of the newly exposed surface. Then the flap is put back in place, reflecting a remodeling cornea that produces better vision.
With IntraLase, a special laser is used instead of a blade to create the flap. Then the usual makes excimer laser ablation.
So in the IntraLase procedure, two lasers are used, why LASIK surgeons sometimes call it “bladeless” or “all-laser” LASIK.
As is typical LASIK, the flap is then replaced to serve as a kind of natural “bandage” for healing.
Advanced Medical Optics (AMO) in 2007 acquired IntraLase, which was integrated into the company CustomVue excimer laser platform. The new system now being marketed as iLASIK.
Taking into account the complications: Blade vs. Bladeless
While LASIK complications are relatively rare, are sometimes associated with the oscillating blade used with traditional microkeratomes. Metal shovels could create flap edges uneven, resulting in abnormal surfaces of the cornea and vision defects as irregular astigmatism.
Metal sheets have also been associated with incomplete or training the right way “buttonhole” flaps that can cause vision-threatening scarring. Many surgeons report eyes such complications are much less likely laser created flaps.
As a replacement for microkeratomes, IntraLase creates through flaps infrared laser energy that introduces a precise pattern of small, overlapping areas just below the corneal surface. The IntraLase laser operates at very high speeds (pulses of a quadrillionth of a second), allowing the tissue to be targeted and divided at the molecular level without heat or impact to the surrounding tissue.
Studies indicate that IntraLase is associated with significantly fewer overall rates of complications of LASIK. However, recently eye surgeons have reported a postoperative complication of unusual sensitivity to light as the photophobia that seems unique in the use of IntraLase LASIK.
Published reports mention this complication has occurred in only 1 percent or as many as 20 percent of patients undergoing LASIK with IntraLase, according to an article in the Review of Ophthalmology, October 2004. (The figure of 20 percent was reported a surgeon, whose IntraLase laser was replaced by the company because compared with other surgeons experiences, the figure was too high, according to the article.)
However, many eye surgeons report that the photophobia complication is temporary and can be resolved with steroid treatment (eye drops) that last a couple of weeks. Eye surgeons favoring IntraLase emphasize that light sensitivity is a transient side effect that is resolved soon, unlike most serious and potentially permanent vision-threatening complications that might result from defective flaps.
However, the disadvantage potential for greater security with the use of IntraLase LASIK procedure is accompanying additional costs of about $ 300 per eye, depending on the Review of Ophthalmology.
In general, patients are given the option of whether they prefer LASIK flaps to be cut with a knife or with the more expensive laser technology, but some surgeons may prefer to use only IntraLase package and may cost in general LASIK payment.
How IntraLase Works
The LASIK surgeon uses a computer program to guide the laser beam IntraLase, which applies a series of tiny (3 microns in diameter) bubbles within the central layer of the cornea. The resulting corneal flap is created in precisely the depth and diameter pre-determined by the surgeon.
As a mechanical microkeratome, a small section of tissue at one edge of the flap is left uncut, forming a hinge that allows the surgeon to fold the flap to the cornea can be accessed and reforming the correction of vision.
Comparing with traditional LASIK IntraLase:
The difference lies in the corneal flap
With IntraLase, people with thin corneas who once were unsuitable for LASIK can now be candidates. Most people have corneas that are between 500 and 600 microns thick, and most microkeratomes cut flaps ranging between 100 and 200 microns thick. Because of its accuracy, the IntraLase seems more capable of reliably and consistently producing the thinner corneal flap 100 microns.
This means that surgeons are now more options for LASIK in people with thinner and flatter corneas, according to Vance Thompson, MD, Sioux Falls, SD, refractive surgeon with experience with IntraLase.
IntraLase in some cases may present fewer complications of LASIK. The IntraLase laser flap follows the curvature of the cornea and produces a flap with easily managed vertical edges, unlike related microkeratomes thin edges that could tear more easily. This difference in the structure flap may reduce the chances of growth below cells and pushing up the tab (epithelial ingrowth) to create a corneal surface with irregular defects of vision.
Other complications such as “buttonholed” or flaps also formed part could be avoided with IntraLase. Because of its sterile system, IntraLase may also be associated with decreased chances of eye infection or contamination.
The IntraLase laser uses a vacuum suction ring to celebrate the eye, compared with a greater vacuum used for microkeratomes. However, the time needed (up to a minute) for the suction ring to stay in the eye with the IntraLase may slightly increase the chances of some superficial bleeding in the whites of the eye (subconjunctival hemorrhage). This type of temporary eye bleeding is not the vision-threatening, and resolves on its own.
People who have had previous corneal surgery often are candidates for LASIK with IntraLase. Dr. Thompson reports that it now uses lasers to create flaps most people who have undergone corneal previous surgeries as radial keratotomy (RK), an outdated vision correction surgery that involved making cuts in the cornea.
After the IntraLase procedure
The recovery is similar to that of traditional LASIK. After surgery, some patients (as with traditional LASIK) have reported feeling eye irritation for up to two days.
While some studies indicate that more people achieve 20/20 vision or better with a flap IntraLase than with a microkeratome-flap Indeed, another study results are inconclusive or better visual results show when used microkeratomes (Review of Ophthalmology ). The survey results have shown that with IntraLase LASIK can produce a lower incidence of post-operative dry eye. Fewer improvement ( “touch-up”), the procedures seem to be necessary as is done with IntraLase LASIK.
According to Dr. Thompson, made by laser flaps seem to adhere more closely to the cornea bed at the end of the procedure and demonstrate a more aggressive healing response at the edges compared with microkeratome flaps indeed. Dr. Thompson said that some microkeratome flaps, rather than adhering to the cornea, can still be easily lifted many years after surgery.
Summary
The “all-laser” LASIK, using the IntraLase laser and an excimer laser, can avoid some microkeratome complications related to the cornea, as irregularities and scarring, which can degrade the picture.
But the plan significantly increased costs of IntraLase procedure if used with LASIK. Moreover, IntraLase has been associated with a complication that causes sensitivity to light, although eye surgeons report that steroid eye drops resolved the situation.
More surgeon with experience in computer-guided laser LASIK flaps and creating a new analysis of its results should confirm whether IntraLase is a significant advance.
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