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Choice of technique (LASIK, PKR, etc.)

The choice between LASIK and PKR)surface laser) concerns mainly the correction of myopia. For the correction of hyperopia, LASIK is a technique of choice: the hypermetropia usually have corneas thick and resistant than short-sighted. Some short-sighted have corneas over thin or irregular, which can lead to reconsider the indication of LASIK for the benefit of the laser surface.

Operation of myopia, hyperopia, and astigmatism: choose which technique?

 

Choice of technique for the correction of myopia

 

When a laser for myopia correction is considered, the choice of surgical technique is between:

-techniques with cut-of flap or flap (LASIK)

-techniques without cutting flap (surface laser = PKR and its variants).

Up to 6 diopters of myopia to correct, there is no difference to the effectiveness of these techniques. In the past, there is less risk of sous-correction in LASIK. The choice between LASIK and laser surface for less than 6 d myopia is based on various clinical elements, and anatomical restrictions mainly due to the thickness and the regularity of the cornea (corneal topography study, possibilities of LASIK correction offered by corneal thickness).

 

Constraints of the cornea

To understand the issues and the indications of the myopia surgery, some reminders are necessary
The cornea is a transparent membrane composed of several layers of tissue. Of these layers, the epithelium represents about 10% of the corneal thickness, while the stroma occupies almost the entire remaining thickness. The epithelium and the stroma are separated by a thin, acellular layer called Bowman's coat. The thickness of the corneal dome is not constant, as the cornea is thinning from the edges (about 650 microns) to the center (530 microns on average).

Constraints of corneal thickness

The profile of ablation laser issued by laser for the correction of myopia involves a maximum tissue ablation, which is going to be carried at the Center of the cornea, next to the constitutionally finest box it. Any myopia in LASIK surgery must respect a minimum residual thickness of the corneaequal to about half of the initial thickness, or about 250 microns.

constituent layers of the cornea

The cornea is a tunic transparent, consisting of 3 main layers: epithelium, stroma and endothelium.

Indeed, with the technique of LASIK, the photoablation is performed in the stromaunder a component superficial whose thickness is between 100 and 130 microns about. The flap is cut by a femtosecond laser (or the mechanical microkeratome in the centres which are not equipped with femtosecond technology). Femtosecond laser is particularly indicated in case thin cornea, or "narrow" orbital conformation because the flaps cut to the microkeratome have sometimes better than what was desired thickness.

Even if he is rested after realization of the photoablation, the stromal flap no longer involved in the biomechanical stability of the cornea. Thus,. the sum of the thickness of the flap and the depth of ablation laser must be maximally such that, subtracted from the initial thickness of the cornea, a value of Wall residual stromal posterior at least equal to 250 microns can be obtained. In LASIK, there is maintenance of the epithelial layer, which explains the speed of Visual recovery (the central surface of the cornea remains smooth and intact). The sensory nerves in the cornea section largely explains the absence of pain Ocxxx_xxx_5163ionnees. The cutting of the flap, however, involve peripheral circular section of the epithelium: this is why that transient discomfort or difficulty to open the eyes is often felt in the first hours after LASIK.

In a technique known as ' surface ' (PKR), the laser is issued to the» surface of the stroma (layer of Bowman)after peeling of the epithelium located in the center of the cornea. A contact lens is usually asked at the end of the surgery, in which the epithelium pushes in some days.

difference lasik pkr photoablation site

In LASIK, the excimer laser photoablation is issued within the corneal stroma, after cutting of a flap which consists of the epithelium, the layer of Bowman and the stroma. The total thickness of the flap is usually programmed to 110 or 120 microns with the femtosecond laser. Surface laser (PKR), the epithelium is removed manually, and the photoablation is issued on the Bowman layer (which is the most superficial part of the corneal stroma)

 

Prevention of corneal ectasia

The  Keratoconus is a condition which corresponds to a progressive deformation of the cornea, caused by a decrease in stiffness of the cornea and which is accompanied by a reduction in the thickness of the cornea in its central region. It causes evolutionary and irregular astigmatism which in severe forms can no longer be corrected in full by glasses glasses. Diagnosis of forms beginner or turned of Keratoconus occurs during adolescence or adulthood due to corneal topography.

Keratoconus is a absolute contraindication to LASIK. Advanced forms of Keratoconus screening is easy, but beginner shapes, called infra clinical, much less...

Indeed, the realization of a LASIK on a cornea damage of Keratoconus is unknown (one speaks of sub clinical form or form not detected fruste) before surgery is the main cause of post-LASIK ectasia. The cutting of the flap and consecutive to the myopic photoablation central thinning are certainly the triggering factor, because they participate in the aggravation of the biomechanical corneal wall weakness.

An important part of our research is devoted to the study of medium screening very beginner forms of Keratoconus, which is not always obvious and requires a fine interpretation of preoperative topographic maps (you can find articles dedicated to this issue for download on this site). We have developed a software testing automated for the prevention of the corneal ectasia that uses topographic data from the study of the faces prior and posterior of the cornea, as well as its thickness: SCORE Analyzer software.

We have indeed acquired the conviction that corneal topography should interest not only the front (anterior) of the cornea, but also its back side (posterior) and allow the creation of a map comprehensive corneal thickness at each point. (ex: Orbscan topography). The measurement of the thickness of the cornea with a ultrasonic method (ultrasonic product) we appears suboptimal insofar as, unlike the product or optical tomography (rear elevation anterior topography), it is not possible to determine with certainty the point of minimum thickness of the cornea. The measure of biomechanical properties of the cornea brings additional elements; the measurement of the hysteresis and corneal resistance carried out by the Ocular Response Analyzer (CH, FIU) instrument can often confirm a doubt when the possibility of a fragility corneal pre existing.

When should you prefer the PKR LASIK?

If the cornea is particularly thin (less than 500 microns in the Center), and slightly irregular curvature, and its biomechanical resistance index is lower than normal. a technique of LASIK may be questioned. A technique of photoablation of surface (including referred to as variants PKR, LASEK, or Epi LASIK represent only few differences to the patient in terms of feeling post-operative) would, however, possible, if the correction is Interior to about 6 D.

Insist on the fact that the Beginner Keratoconus is a contraindication formal to the realization of a LASIK technique, and this regardless of the initial thickness of the cornea, and the type of cutting (microkeratome or laser femtosecond). Only corneal topography to ensure screening, supported by a measure of corneal biomechanics. Modern techniques of topography combine study of the anterior curvature, and the collection of the rear elevation and the study of the variations of the corneal thickness (CT): Orbscan, Pentacam, etc.

In summary: choice between LASIK and PKR

Corneas after 'successfully' topographic tests and biomechanical resistance may be operated in LASIK. The cutting of the flap will be made with the femtosecond laser and its thickness will be determined based on the topographic and eye of the patient characteristics. It will be even thinner that the cornea is thin and myopic correction is important. This cut is in all case followed by photoablative corrective step (excimer laser).

When there is a doubt about the ability to undergo a LASIK conducting, a surface photoablation technique (PKR, less invasive but painful 24 hours approximately to the waning of the surgery) will be proposed. The absence of cutting of the stromal flap better preserves the potentially fragile biomechanical corneal wall rigidity.

There is no 'best' technique in general, but there are sometimes a 'better' technique for a particular patient. The choice of the most suitable technique is the responsibility of the surgeon, and is the first step of the 'key' to a successful refractive surgery procedure. Safety is the key parameter to choose between different possible techniques in a given patient. The important thing is the long term, and the 'comfort' aspect should not prevail on practical considerations or "marketing."

 

Correction of hyperopia and the strong astigmatismes

These corrections require the achievement of ablation profiles whose geometry involves a large amount of tissue photoablation. LASIK is the technique of choice for these corrections. Keratoconus is almost always associated with a certain degree of myopia, the risk to operate a fragile cornea (Keratoconus beginner) is much rarer in the context of a farsightedness. The correction of hyperopia in LASIK corrects distance vision, but also improves vision closely in the presbyter (see the page dedicated to the) correction of hyperopia in the presbyter).

This property can be used to induce an increase of near vision in some subjects by elsewhere free of disturbances in vision of far (so-called normalsighted issues and presbyopes)- Download article about it

Personalized treatment guided by the Wavefront collection, treatment optimized

Download article "Place of treatments custom aberrometriques.

The vision correction laser using a conventional treatment or conventional allows to correct myopia, hyperopia, and astigmatism, which are responsible for the blurry vision of patients with these visual defects. In some patients, other optical defects called "aberrations of high degree" can also impair vision, particularly night. The ocular wavefront by the aberrometric analysis to detect the optical aberrations of high degree. A high rate of these aberrations can be the indication of a personalized treatment intended to give a vision of better quality than that obtained with standard treatments in certain indications. Indeed, treatment guided by collection of the wave front (custom treatment) are designed specifically to address the very small Visual irregularities specific to each eye and measured using an aberrometer.

This type of treatment offers additional benefits for people whose vision is heavily corrected with glasses or contact lenses. It can even correct irregularities of vision resulting from previous surgeries or injuries. In these rare and special, indications l ' use of information about the fine relief of the cornea can also be used to establish a treatment personalized laser to reshape the cornea (corneal topography-guided treatment).

The preservation of the natural (prolate) asphericity of the cornea can also reduce the risk of nocturnal halos, as well as the choice of a larger treatment area. This approach is intended to minimize the risk of night-time glare and halos, especially for patients whose correction order is high and for those who have large pupils. They are intended to provide the best possible vision, limiting the risk of optical aberrations and maximizing the chances of getting a vision of 12 or even 15/10 after treatment. Treatments called "wavefront optimized" (Alcon Wavelight laser) are designed to best preserve the corneal Asphericity and increase the optical quality of the cornea in post operative with respect to conventional treatments.

Finally, the correction of the strong astigmatismes benefit of the technique of Iris recognitionwhich allows to reduce the risk of "misalignment" (called cyclotorsion) between the axis of astigmatism measured in sitting (the consultation) and lying (during surgery). A mapping of the iris is made during the consultation by an aberrometer. This map is then used to serve as a benchmark for the laser treatment (the picture of the iris of the patient is transferred to the laser, and serves as a benchmark for the issue of the treatment). We have the technologies of active compensation for cyclotorsion during the sequence shot of the excimer laser (Active Compensation, laser Technolas), and the system of correction of the cyclotorsion by limbic, iris recognition and prevention of the pupillary shift (laser Wavelight EX500).

 

Reprocessing in patients operated in the past.

 

The reappearance of myopia, astigmatism, or even a hyperopia after refractive surgery isn't inevitable. It is generally possible to perform a retouch, even many years after the initial surgery.
Old technical, today abandoned in favor of the laser, as the radial keratotomy techniques, revealed some instability of late postoperative refraction. The radial keratotomy was to perform corneal incisions ("kerato-tomies") Star, or even rays (where the name "radiaire"), who were leaving the corneal periphery and stopped at the level of a central corneal area. This technique, invented by a Japanese (Dr. Sato) was popularized by an ophthalmologist Soviet (Dr. Fyodorov) during the 1970s.
The diameter of the central area, as well as the number and arrangement of the incisions were empirically adjusted in function "of plotters" (nomograms). The finding of a progressive sur-correction (hypermetropisation) is not uncommon in patients operated of myopia by radial keratotomy fifteen or twenty years ago. It is all the more annoying that it concerns today quadra topics or quincagenaires.
In most of the case, a remodeling excimer laser is possible to reduce the refractive defect in these patients: reduction of hyperopia excimer laser will allow them to see better from a distance, and also closely.

All of these technologies are available to the Rothschild Foundation (IFS 150 femtosecond laser, femtosecond laser FS200, different types of lasers, excimer such as laser Wavelight EX 500, Technolas Z100, customized and optimized - laser ablation laser ex: wavefront optimized, custom-Q, technology Zyoptix, guided by the Wavefront, of screening anterior and posterior corneal topography, measure the biomechanical resistance of the cornea) treatment guided by corneal topography (topolink), etc...).

39 responses to "choice of technique (LASIK, PKR, etc.)"

  1. […] Choice of technique (LASIK, PKR, etc.) […]

  2. Besnard says:

    Hello

    You don't have to publish my comment; It is first of all a thank you; I went through your site a few minutes at the moment but it seems wonderfully complete, thanks for that.

    I will look for an answer to the following question:
    – While I am myopic,-4.75/-5.00, slightly astigmatism-0.25:

    (1.1) if I'm having surgery to LASIK, should I wear glasses for presbyopia in 10 years?

    (1.2) If Yes, could I have the surgery to correct presbyopia and never wear glasses?
    2.1) If I don't have LASIK surgery and I keep my contact lenses, should I wear glasses for presbyopia in 10 years?

    Sincerely,
    lb

  3. Dr. Damien Gatinel says:

    Presbyopia for all patients, and usually starts around age 45. The game mechanism starts earlier in existence)accommodative capacity reduction of the eye), but when one above does not allow to accommodate comfortably the reading distance (less than 40 cm) that it feels like a gene, and this usually happens to midlife (earlier in the light hypermetropes uncorrected). A LASIK surgery myopic with a total correction becomes Emmetropic and evolution expected for presbyopia is identical to that of a patient who has never been short-sighted. Glasses for reading will be necessary to 45 years. Repeat the refractive myopia does not accelerate the presbyopia.
    In an old myopic surgical refractive surgery by LASIK, then became longsighted, there are methods to compensate for the presbyopia; A surgical recovery consisting of performing a laser retouching to give a (non-director) eye a slight myopia (rocking). This method reduces the dependence on corrective lenses closely. (see myopia and presbyopia)
    If you are not having LASIK surgery and keep contact lenses for vision from afar, it will take more glasses for reading, unless you perform in lenses what is called a "rocker" (under eye correction) or Monovision.

  4. Nico89 says:

    Hello
    Jai 33 years, my visual acuity is to
    OD:-3 (-1.25) 110degres
    OG:-3.75 (-0.75) 65degres
    Pachymetrie:
    OD: 504um by US and 490um by Orb
    OG: 514um by US and 490um by Orb

    I ask myself questions about the technique to do; the femtolasik is discouraged because the cornea is fine, the pkr is an old technique and Visual recovery is slow, the SMILE is a nauveaute without having back.
    Thank you

  5. Dr. Damien Gatinel says:

    In your situation, the PKR priori seems the most appropriate technique. Its 'old' character doesn't mean that this technique has a deprecated character, on the contrary. The PKR, LASIK and the SMile are techniques that could be described as variants around a common theme: the reshaping of the corneal profile. Surface (PKR), it is done by the excimer laser (more accurate) which is particularly interesting for thin corneas (and less than 6 D myopia). In depth, it is performed in SMILE or LASIK. The SMILE has a marketing advantage (the aspect of 'new' but that is not the concept, but using a unique laser to extract a refractive lens), an incision size smaller, but forcing a dissection manual and a cut less specifies that the photoablation under a superficial corneal flap (LASIK). In case of thin corneas, the SMILE does not benefit shown in clinical practice on LASIK, and case of ectasia post SMILE have been reported. The disadvantage of the PKR is not its age but the early postoperative pain (24 h), because it benefits from all the progress made in the field of the photoablation excimer laser, with opportunities far beyond what the SMILE can achieve in terms of balance customized, correction of astigmatism, and size/precision of the depth by impact effect.

  6. Nicolas says:

    Hello
    My acuity is:
    Right Eye-3 (-1.25) 110degre
    Left eye-3.75 (-0.75) 65degre
    The Pachymetrie is about 490 or 500 um depending on the machine
    pupil diameter: Right eye 3.92 left eye 3.88

    a surgeon offered the femtolasik, and another trans-pkr because the cornea is fine.
    I would like to know which method is most relevant to me, in terms of visual acuity and the quality of the view (compared to the diameter of my pupil)?

    I'm a little lost, and need your advice. Thank you

  7. Dr. Damien Gatinel says:

    The measure of pupillary diameter seems to have been made in standard lighting conditions... it would be wiser to repeat in a low light room (so-called conditions mesopiques) to appreciate the diameter of the pupil in Mydriasis (natural expansion). In presence of thin corneas, we carefully inspect the corneal topography as a whole. The most prudent solution in doubt is to realize a PKR whose results are quite superimposable with the LASIK.

  8. Yanis says:

    Hello doctor, I am 21 years old and I have a strong astigmatism and farsightedness l. Correction (29/07/2016) with glasses I see very good 10/10.
    OD: (-2 to 171 deg) + 1.00 D
    OG: (– 2.75 to 175 deg) + 1.25 D
    Can I be operated by LASIK Femto if my cornea allows me and can I have the same view as my glasses gets me?

  9. Dr. Damien Gatinel says:

    You present a congenital priors astigmatism, which is said to be 'mixed', because depending on the angle of the Meridian that refract light, your eye is either nearsighted (maximally on the vertical Meridian) and be farsighted (on the horizontal Meridian)! This type of astigmatism is corrected in femto-LASIK. To use a recent laser platform to get the best results (personal centering, compensation of any cyclo-turning movements of the eye). A review of corneal topography should confirm that your corneas may benefit from this fix.

  10. Cazenave says:

    Hello

    I'd like to know the difference between the Laser Intrastromal Keratomileusis and femtosecond laser. I'd like to have surgery for presbyopia and I am farsighted and astigmatism.
    Very cordially.

  11. Dr. Damien Gatinel says:

    The femtosecond laser is an "instrument" that allows to cut the cornea (ex; make a flap of LASIK, or incisions, or "corneal tunnel", etc). LASIK is a technique which today using a femtosecond laser to achieve a superficial flap.

  12. Shaft says:

    Hello

    I have to have surgery, I still hesitate between lasik and the pkr. I have a combat sport afterwards. My doctor says that there is little risk that the flap rises following a shock but that it was already happened with lasik what do think you and do you recommend especially. Lasik makes you it really so fragile eye

  13. Dr. Damien Gatinel says:

    The uprising of the flap in LASIK risk is tiny, and not against not indicate the practice of combat sport. The flap sticks in 24 to 48 hours, and although a violent trauma can then move it (in theory), in practice he should imagine a violent accident and whose direction corresponds exactly to the cleavage of the flap plan. This kind of trauma causes anyway significant ocular lesions, flap or not. It is therefore not at all discouraged practice combat sports, rugby, and military, gendarmes, members of the RAID and other special forces or commandos (France and USA) are operate in LASIK to correct vision disorders.

  14. Vera says:

    Hello
    I wish to have your advice on choosing a refractive surgery and these latest advances. I consulted a surgeon in 2014 with a miopie-3.75 on both eyes. I have a fine cornea and I have an ocular drought that does not allow me to wear lenses. He offered me epi-LASIK. Is there any progress in recent years on this technology, because I understand that the post operation is painful and that there is a mechanical phase PDT the operation. is the choice of refractive surgery recommended for people with drought?
    Thank you for coming back.

  15. Dr. Damien Gatinel says:

    Epi LASIK is a variation of the PKR (surface laser), which does not benefit from it, or even drawbacks if we rest the epithelium on the cornea rather than remove it. If your cornea is fine, it is certainly preferable to opt for the PKR (surface laser). Dry eye is a generic term that covers many different situations. Many patients consult when drought makes difficult the extended wear lenses. In the absence of corneal complications, dry eye is not a formal contraindication to refractive surgery

  16. Abir says:

    Hello, I have a myopia of-7 and -9 with a thin cornea 460 y' has you it a hope for me to correct my nearsightedness?
    Thanks in advance for your answer

  17. Dr. Damien Gatinel says:

    In your case, it is not possible to make a correction to the laser, because your degree of correction is too high for the PKR. Based on some parameters like your age and some other eye characteristics, by implant surgery can be proposed.

  18. Pier says:

    Good evening
    I have an appointment for an operation this week of myopia (-2 to each), and my surgeon only dispenses the PKR technique.
    He explained to me the possibility of issuing a work stoppage for a week, so that my vision would recover as much as possible. But I thought it was not possible to receive this. Am I mistaken?
    In addition, he indicated to me a follow-up by eye drops for 4 months. And the number of instillation per day (every hour, so 15 day single doses) is therefore, especially at the rate of the product. Is it always like this?
    I did not see any information on the post-operative follow-up and administration of eye drops or anything else on the site, hence my question. If I missed this information, I apologize.
    Thanks for your reply.

  19. Dr. Damien Gatinel says:

    Refractive surgery may result in the issuance of a work stoppage because this surgery is considered as ' comfort' and is not reimbursed by social security. Apart from artificial tears, there is no eye drops to instill every hour, and if tears (or the solution of hydration) is suggested to you is expensive, you can replace it in whole or part by simple saline.

  20. David M says:

    Hello

    I have a myopia a-6 § coupled to a slight astigmatism; My surgeon tells me that my eyes are good candidates for LASIK and PKR, and asks me to choose between the two, but without actually arriving has to provide me with a rational element to decide other than that of convalescence more or less fast and Comfortable and the price.

    I wish the best technique for my eyes and my future life, is there really any sensible difference?

    I am thinking specifically about the accuracy of the result or the risk of eye dryness/halo.

    From the tests carried out during my consultation I have a large pupil and naturally slightly dry eyes (although not providing me with discomfort at the moment).

    Thank you.

  21. Dr. Damien Gatinel says:

    It is not necessarily unusual for your surgeon to leave you the choice between these two techniques; The comfort surgery has a "personal" dimension, and when these two techniques are possible, it can be left to the patient the choice to opt for one or the other. That said, for a myopia of-6 D, I tend to advise LASIK, if the drought felt is not accompanied by keratitis, etc. The "precision" of LASIK is slightly greater than-6 d left precisely (it is not so much the difference in precision between the techniques, as the slightest epithelial scarring that LASIK arouses). The comfort and the possibility of retouching, even very late (several years), and always in a comfort situation are other things to consider.

  22. Lou says:

    Hello

    I am 33 years old and in order to correct my myopia I met several surgeons.
    OD-2.5 (-1.25) 90
    OG-2.25 (-0.25) 65
    All offer me Lasik in the first place.
    When I ask them about the PKR that seems to me less invasive, it is also conceivable but as I have a thick cornea, does not do violent sport, that we recover faster, I am directed to LASIK. The last surgeon explained to me that my astigmatism incited him to possibly make an eye in PKR but the other in Lasik.

    I tend to defer to their judgment and at the same time ask me if the financial aspect does not steer their decision. For my part the difference in recovery time or cost does not enter the balance for such an operation.

    What do you think? Thanks in advance

  23. Robert says:

    Hello!
    My turn to ask questions about these interventions.

    I have a myopia of-4 and I seem to have a very good cornea.

    My ophthalmologist offers me 2 techniques: epi-LASIK and LASIK.
    LASIK has the advantage of being less painful and quickly retrieving the view.
    Epi-LASIK seems more painful for 2-3days and it takes 1 month to completely recover the view. It seems more restrictive but less chance of complications (1/1000 versus 1/100 for LASIK).
    The surgeon explained to me that if he had to advise S.O. of his family he would tell him the Epi-LASIK because it is not a player... but that LASIK was very good too....

    How to make a choice?

  24. Robert says:

    Hello!
    I'm myopic at-4, I'm offered the 2 techniques, which one to choose?

    Thank you!

  25. Dr. Damien Gatinel says:

    If both are possible, then there is no mistake in choosing one or the other. LASIK is usually chosen by patients for the speed of recovery and the absence of pain during the first 24 h.

  26. Dr. Damien Gatinel says:

    LASIK is a very safe technique. The progress made in the realization and delivery of treatment has nothing to do with a "game" or any "lottery". Nothing is left to chance, and even if the risk of complication is not zero, it is small (and does not play the visual prognosis), and you can consider serenely this surgery if you are eligible, and the centre where you intend to be operated is "aux nor (Laser femtosecond, recent generation lasers, etc.).

  27. Dr. Damien Gatinel says:

    The Council to carry out a LASIK is not a priori mu by a financial interest. LASIK is now a proven technique, and if that was not the case, it would not be proposed. LASIK also allows for the consideration of medium and long-term retouching (10 years and more), which can be interesting in case of late myopia, or installation of a presbyopia, etc. If we add to this the absence of pain, there is not necessarily much interest in proposing PKR in a patient with thick, contraindications-free corneas with LASIK surgery.

  28. Paul says:

    Hello
    Is it possible to do a LASIK recovery on a radial keratotomy carried out in 1992?
    This method seems more predictible than the Excimer laser....
    Thank you for your information

  29. Dr. Damien Gatinel says:

    In theory LASIK is more accurate in this kind of correction (hyperopia) but the presence of corneal incisions can make it difficult to create a flap of LASIK and expose to some complications. The PKR (surface laser) has the advantage of not exposing to them.

  30. Patricia says:

    Hello, I have 33 years and-6.75 in the right eye with a very slight astigmatism (not corrected because I see no difference) and-6.5 to the left eye. After exams we found a "doubt" of keratoconus fruste in the right eye. LASIK is therefore ruled out for the right eye. I am offered a PKR or epi-LASIK. Yet I read about it was not possible with my myopia. My right eye is it compatible with a PKR or epi-LASIK? and is it possible to make a LASIK to the left eye that does not present keratoconus fruste and a surface technique has the right eye? Thank you, sir.

  31. Dr. Damien Gatinel says:

    The first thing to do is to find the cause to the corneal distortion of the right eye. We have discovered that these aspects are mainly related to the realization of eye rubbing and repeated, and that in case of unilateral interference, it is logically a unilateral friction... Most of the time, the patients in question sleep on the side or on the belly by pressing the reached eye (right in your case). This extended nocturnal support is a source of irritation, and triggers chronic eye itching. You will find many explanations and links on this site. Once the cause carry (eg: friction automatic repeated), it is necessary to stop this one. If the right cornea is really distorted, it is best not to perform LASIK in all case, but a PKR may still be considered, even if there is a moderate risk of under-correction in your home. It is also better to opt for PKR on the other eye, if you stick to the "rules of the art" and the prudence. As you will have understood, I do not consider keratoconus to be a genetic or hereditary disease, but as an expression of repeated ocular (corneal) trauma. Nevertheless, for the time being, it is necessary to stick to the rules of good practice, and the realization of a PKR is the only legitimate photoablative surgery in a patient who has an anomaly of this type.

  32. Mya says:

    Hello doctor GATINEL,

    I consulted two practitioners, both of which led me to a PKR. However the second is waiting for me to do other exams to decide whether to operate or not because it considers that my cornea is below 470 um and is therefore quite fine. I would like to know if there is a consensus among the Rétractifs surgeon community regarding a minimum cornea thickness to be operable by PKR.
    I'm in correction scope to:
    OD:(5 °-2.25)-4.0
    OG:(175 °-1.75) – 3.75
    My 2-year Orbscan results indicate:
    OD: Thinnest: 451 um @ (-0.4,-0.5)
    OD: Thinnest: 454 um @ (0.2,-0.6)

    Thanks in advance
    Mya (23 years old)

  33. Dr. Damien Gatinel says:

    It is indeed difficult to give you a threshold in below of which PKR is not proposed. It is necessary to inspect the topography of your corneas, to appreciate their regularity... Corneas that are congenitally fine are often compatible with performing a surface laser type surgery (PKR). It is more uncertain to place this indication in case of progressive thinning (usually related to the occurrence of repeated eye rubbing). If your corneas are regular and you do not rub your eyes, an intervention may be considered.

  34. Akim says:

    Hello doctor

    I hope you're okay?

    I've been following you for five years for a keratoncone.

    The latter does not evolves or very little on the other hand astigmatism has evolved enormously and it becomes annoying.

    I can't stand any lenses and the glasses will correct me more than enough.

    I saw a video of one of your confreres explaining that LASIK is possible when the keratoconus is stable.

    What do you think?

    Thanks in advance

  35. Dr. Damien Gatinel says:

    LASIK is formally contraindicated in case of keratoconus, stable or not. On the other hand, the surface laser (PKR) is possible in some case (stability of the keratoconus, obtained when the eye rubbing ceases, and correction compatible with the indications of PKR).

  36. Florence says:

    Hello
    I was in a myopia surgery six years ago.
    I come back from my attending doctor or I learned that boxing was absolutely against indicated in case of refractive surgery. She advised me to check with a sports doctor, as far as it comes to French boxing (bcp of keys and less assault). I also find that PKR is less intrusive, and that's what I got six years ago. Is there still a chance that I can do this sport?

  37. Dr. Damien Gatinel says:

    Corneal refractive Surgery (LASIK or PKR) is compatible with boxing, as with combat sports in general. That said, regardless of any surgical considerations, myopic eyes are more fragile to impacts, and boxing can accentuate the risk of retinal detachment in case of repeated shocks in the Cephalic region. So it's important to make a full balance sheet.

  38. Laila Hajji says:

    Hello doctor,

    I recently consulted an ophthalmo for a retractive surgery, I was confirmed with the date to be operated with LASIK, except that on the day of the operation I am told that there is no solution other than the implant to correct the view. Knowing that I have a strong myopia
    OD:-5.00
    OG:-5.50
    And I have a very fine cornea equal to 445 UM.
    What should I do? Consult another ophthalmo to see if there is a possibility to do the PKR.

    Thank you

  39. Dr. Damien Gatinel says:

    Indeed, your myopia cannot be corrected in LASIK (in General, the thickness of the cornea is measured well before the day of the intervention to determine the operability of the patient). A PKR can be considered a priori.

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