Femtodynamics A Guide to Laser Settings and Procedure Techniques to Optimize Outcomes with Femtosecond Lasers

by Faktorovich, Ella

• ISBN13: 9781556428623
• ISBN10: 1556428626
• Edition: 1st
• Format: Hardcover
• Copyright: 2009-04-15
• Publisher: Slack Incorporated

Summary

Femtodynamics: A Guide to Laser Settings and Procedure Techniques to Optimize Outcomes with Femtosecond Lasersis a new, comprehensive text that presents a practical approach to optimizing laser settings and procedure techniques for performing LASIK, intracorneal ring segment placement, and other corneal procedures with currently available femtosecond lasers. Dr. Ella Faktorovich has provided detailed photographs and illustrations to demonstrate the techniques for optimizing procedure outcomes. The author guides you step-by-step through common procedures while providing a detailed approach to managing and preventing possible complications. Topics covered include: bull; Strategies for centration bull; Decreasing the incidence of opaque bubble layer formation bull; Optimizing the energy delivered to the cornea bull; Improving the quality of dissection As the first book on femtosecond laser application to corneal surgery,Femtodynamics: A Guide to Laser Settings and Procedure Techniques to Optimize Outcomes with Femtosecond Lasersis a useful guide for beginning surgeons as well as surgeons looking to develop or enhance their working knowledge of femtosecond lasers.

Author Biography

Ella G. Faktorovich, MD is a corneal and refractive surgeon in San Francisco, CA. She received her B.A. in Molecular Genetics from UC Berkeley, where she was elected Phi Beta Kappa, and her medical degree from UC San Francisco School of Medicine, where she was elected Alpha Omega Alpha. While a medical student, Dr. Faktorovich developed techniques for retinal transplantation and intraocular injection of growth factors to rescue photoreceptors in eyes with retinal degeneration. She completed her residency in ophthalmology at the UC San Francisco School of Medicine, where she became interested in refractive surgery. She then completed a fellowship in cornea, external diseases, and refractive surgery at the Jules Stein Eye Institute UCLA School of Medicine. During her fellowship, Dr. Faktorovich pursued research on corneal wound healing and methods of pain control after refractive surgery. Upon returning to San Francisco, Dr. Faktorovich established Pacific Vision Institute, where she has worked since. She is the founder and remains the Chair of the San Francisco Cornea, Cataract, and Refractive Surgery Symposium, which is currently in its 8th year and brings together the leaders in corneal and lens surgery. In addition to her busy clinical work, Dr. Faktorovich remains active in multiple research projects. She enjoys finding innovative solutions to common and uncommon dilemmas in corneal and refractive surgery.

Table of Contents

Dedication

Acknowledgments

About the Author

Foreword

Preface

History and Applications of Femtosecond Lasers

Principles of Laser-Matter Interaction Femtosecond Lasers

Applications of Femtosecond Lasers

Femtosecond Lasers in Corneal Surgery

Introduction

Mechanism of Corneal Femtodissection

Femtosecond Laser Systems for Corneal Femtodissection

Femtosecond LASIK Flap

Femtosecond Channels for Intracorneal Ring Segments

Femtosecond Corneal Transplantation and Other Procedures

Principles of Femtodynamics

Overview Centration Process

Quality of Dissection

Opaque Bubble Layer

What Is OBL and Where Does it Come From?

OBL Due to High Energy

OBL Due to Low Energy

OBL as a Guide for Optimizing

Laser Settings and Procedure Techniques

Postoperative Findings

LASIK With AMO Femtosecond Lasers: Laser Settings

Technical Features of AMO Laser Systems (Intralase and iFS)

Overview of Laser Settings for LASIK Flap Creation Pocket Specifications

Overview Pocket

On/Off Pocket

Depth Pocket

Width Pocket-Flap

Overlap Pocket

Ramp Spot Separation Pocket

Energy Pocket

Position Hinge Parameters

Overview Hinge

Angle Hinge

Position Flap Bed Parameters

Overview

Flap Bed Laser Pulse (Spot and Line)

Separation Flap Bed (Raster)

Energy Flap

Diameter Flap

Thickness Flap

Thickness in Corneas With Scars and Epithelial Basement Membrane

Dystrophy Flap

Side Cut Parameters

Side Cut Angle

Side Cut Energy

LASIK With AMO Femtosecond Lasers: LASIK Procedure Techniques

Overview

Positioning the Suction Ring

Overview Centering on the Line of Sight Strategies for Maximizing Stromal Bed

Exposure in Eyes With Decentered Line of Sight

Docking the Applanation Cone

Overview Head and Eye Position Applanation

Avoiding Parallax Error During Docking

Meniscus Avoiding False

Meniscus Fine-Tuning Flap

Centration on the Video Display Moving the Pocket Close to the Meniscus

Centering the Flap on the Optical Zone

Lifting the Flap

General Principles

Two-Step Technique

One-Step Technique

Repositioning the Flap

General Principles

Technique 1

Technique 2

Repositioning the Flap if Stretch

Striae are Present Enhancement Techniques

LASIK With AMO Femtosecond Lasers: Getting Started

Overview

Mastering Applanation

Mastering Flap Lift Optimizing

Energy Settings: Where to Begin?

Postoperative Findings

Summary

LASIK With AMO

Femtosecond Lasers: Troubleshooting

OBL Causes Solution Pocket

OBL Pocket/Bed

OBL Bed

OBL Pocket

OBL Pocket/Bed

OBL Bed OBL

OBL in the Area of Ablation, Tracking, or Iris Registration Causes Solution

Difficult Flap

Lift/Flap

Lift in the Area With OBL

Causes Solution

Flap Stretch Causes Solution

Flap Striae Causes Solution

Flap Tear Causes Solution

Peripheral Tags Causes Solution

OBL, Difficult Flap Lifts, and Peripheral Tags Despite Optimized Laser Settings and Techniques Causes Solution

Loss of Suction Causes Solution

Vertical Gas Breakthrough Causes Solution

Horizontal Gas Breakthrough Causes Solution

Bubbles in the Anterior Chamber Causes Solution

Difficulty Tracking and Iris Registration During Excimer Laser Ablation Causes Solution

Subconjunctival Hemorrhage Causes Solution

Decreased Visual Acuity at Postoperative Day One Causes Solution

Peripheral Lamellar Keratitis Causes Solution

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