An Enzymatic Technique to Facilitate Air Separation of the Stroma Descemet s Membrane Junction
|
|
- Lorraine Cooper
- 8 years ago
- Views:
Transcription
1 Cornea An Enzymatic Technique to Facilitate Air Separation of the Stroma Descemet s Membrane Junction Edgar M. Espana, 1 Bo Huang, 1 Jonathan Fratkin, 1,2 and Jeffrey Henegar 2 PURPOSE. To describe an enzymatic technique that facilitates air separation of Descemet s membrane from the corneal stroma. METHODS. Fresh human corneoscleral tissue was mounted on an artificial anterior chamber. In a control group, air was injected into the stroma. A second group received a stromal injection of 2.5 mg/ml collagenase type 2 in balanced salt solution that was left in the stroma for 1 hour and 15 minutes. A third group received an injection of 2.5 mg/ml collagenase type 2 in balanced salt solution followed 1 hour and 15 minutes later by an injection of air into the stroma. All injections were performed with a 27-gauge needle into the deep stroma without penetrating Descemet s membrane. Anterior segment optical coherence tomography (AS-OCT), histologic examination, and electron microscopy of the junction between the stroma and Descemet s membrane were performed. The trypan blue exclusion and TUNEL assays were used to study endothelial cell viability after collagenase incubation. RESULTS. Injection of air or collagenase into the deep corneal stroma did not result in a reproducible separation of the stroma Descemet s junction. In contrast, the stroma was easily and reproducibly separated from Descemet s membrane with a combination of intrastromal collagenase and air injection. The separation was confirmed by using light and electron microscopy. The cleavage plane seemed to be located between the junction of the posterior stroma and the anterior banded layer of Descemet s membrane. Trypan blue staining demonstrated the viability of endothelial cells after collagenase incubation. TUNEL assay confirmed excellent viability after collagenase air separation. CONCLUSIONS. This technique facilitates the separation of Descemet s membrane from the stroma without affecting endothelial cell viability. (Invest Ophthalmol Vis Sci. 2011;52: ) DOI: /iovs A technique that separates Descemet s membrane from the corneal stroma is potentially useful for the advancement of either anterior or posterior lamellar corneal transplantation. It is believed that a Descemet s membrane-to-stroma interface can yield a better final visual outcome than a stroma-to-stroma interface. A reproducible and simple technique for separation of Descemet s membrane from the corneal stroma would be of great importance for Descemet s membrane endothelial keratoplasty (DMEK) and deep anterior lamellar keratoplasty (DALK). From the Departments of 1 Ophthalmology and 2 Pathology, The University of Mississippi Medical Center, Jackson, Mississippi. Submitted for publication September 14, 2010; revised June 13, July 27, and September 3, 2011; accepted September 20, Disclosure: E.M. Espana, None; B. Huang, None; J. Fratkin, None; J. Henegar, None Corresponding author: Edgar M. Espana, University of South Florida Eye Institute, Bruce B. Downs Boulevard, MDC 21, Tampa, FL 33612; edgarespanamd@gmail.com. A critical step for a successful DMEK transplant is the preparation of the donor graft consisting of an intact Descemet s membrane with viable endothelial cells. Tissue procurement and handling of the delicate Descemet s membrane may result in membrane tears and loss of valuable tissue. Different Descemet s membrane harvesting techniques, are reported, and modifications are frequently published. Ignacio et al. 1 peeled Descemet s membrane from a donor corneoscleral rim mounted with the endothelium facing up on an artificial anterior chamber. Tappin 2 peeled Descemet s membrane and used it in corneal transplantation. Lie et al. 3 described a novel harvest and implantation technique using trypan blue and forceps to remove the membrane from the stroma. Price et al. 4 reported the SCUBA (submerged corneas using backgrounds away) technique. Busin et al., 5 Studeny et al., 6 and McCauley et al. 7 described variations with a big bubble used to isolate donor Descemet s membranes. Recently, Kruse et al. 8 published a modified technique to isolate Descemet s membrane by using a razor blade and two forceps to improve endothelial cell survival. The collagenolytic activity of collagenase, obtained from Clostridium histolyticum, is currently approved by the U.S. Food and Drug Administration for the clinical management of Peyronie s disease 9 and is currently being evaluated for Dupuytren disease. 10,11 We present an enzymatic technique using collagenase obtained from Clostridium histolyticum that creates a cleavage plane at the stroma Descemet s membrane interface and facilitates air separation of Descemet s membrane from the corneal stroma. MATERIALS AND METHODS Descemet s Membrane: Stroma Separation Techniques Fresh human corneoscleral tissue, preserved in storage medium (Optisol; Chiron Vision, Irvine, CA) and not suitable for transplantation was obtained from the Mississippi Lions Eyebank (Flowood, MS). The tissue was obtained and managed according to the Declaration of Helsinki. The corneoscleral tissue was mounted on a Barron artificial anterior chamber (Katena Products Inc., Denville, NJ). In a control group (n 5), air was injected into the deep stroma, although most likely there was some variation in the depth at which it was injected in each eye. Air injection was performed with a 27-gauge needle with the beveled edge facing the Descemet s membrane as described in the big bubble technique. 12 A small air bubble was left in the artificial chamber that helped to visualize Descemet s folds. A second group (n 5) received a stromal injection of 0.3 ml of 2.5 mg/ml collagenase type 2 (Worthington, Lakewood, NJ) in commercial balanced salt solution (BSS; Alcon, Forth Worth, TX) also using a 27-gauge, beveled needle. The solution of collagenase was left in the stroma for 1 hour and 15 minutes at room temperature. Finally, a third group (n 18) received an injection with 0.3 ml of 2.5 mg/ml collagenase (Figs. 1A C) that was left in the stroma for 1 hour and 15 minutes, at which point an injection of 0.7 ml of air into the deep stroma with a 27-gauge, beveled Investigative Ophthalmology & Visual Science, December 2011, Vol. 52, No. 13 Copyright 2011 The Association for Research in Vision and Ophthalmology, Inc. 9327
2 9328 Espana et al. IOVS, December 2011, Vol. 52, No. 13 FIGURE 1. Surgical microscope view of the procedure. A corneoscleral rim is mounted on a Barron artificial chamber (A). A 27-gauge needle is advanced, bevel down, over an air bubble to facilitate visualization of Descemet s membrane (B). A collagenase solution is injected into the corneal stroma (C). Air is then injected into the corneal stroma (D). needle was performed (Fig. 1D). Air was easily dispersed into the cornea stroma (see Supplementary Video S1, lookup/suppl/doi: /iovs /-/dcsupplemental). After the separation of Descemet s was attempted, corneal tissue was fixed in formaldehyde for paraffin sectioning or in OCT (optimal cutting temperature compound; Tissue-Tek; Sakura Finetek, Torrance, CA) for cryosections. Establishing the Appropriate Enzymatic Digestion Time To better determine and establish the incubation time needed to create a separation cleavage plane using collagenase, human corneoscleral tissue mounted on the artificial chamber received an injection of 0.3 ml of 2.5 mg/ml collagenase in balanced salt solution. Two different collagenase doses were evaluated: 1.25 and 2.5 mg/ml. For each of the above concentrations, collagenase was injected into the stroma for 25 (n 2), 50 (n 3), 75 (n 3), and 100 (n 3) minutes. An injection of 0.7 ml of air into the deep stroma was then performed as described above. Light and Electron Microscopy and Anterior Segment OCT Imaging Corneal sections were examined by light and transmission electron microscopy. For transmission electron microscopy, corneal tissue was fixed in Carson-Millonig buffered formaldehyde, postfixed in 1% osmium tetroxide, dehydrated through a graded ethanol series, and embedded in epoxy resin (Eponate 912; Ted Pella, Inc., Redwood, CA). Ultrathin (70 nm) sections were collected on copper grids and stained for 1 hour each with uranyl acetate and lead citrate before examination by transmission electron microscope (Leo 912; Carl Zeiss Meditec, Dublin, CA). Corneoscleral tissue after collagenase intrastromal injection, as described above, and after incubation for 75 minutes and air separation was mounted on a Barron artificial anterior chamber (n 3) and evaluated with AS-OCT (Visante; Carl Zeiss Meditec) to further demonstrate Descemet s membrane separation. Trypan Blue Dye Exclusion Test Three pairs of corneoscleral rims from three different donors were used to evaluate cell viability after Descemet s isolation by mounting three of the six rims on a Barron artificial anterior chamber, with storage medium (Optisol; Chiron Vision) filling the endothelial side of the chamber. Contralateral eyes, without any enzymatic treatment, were used as a control group to evaluate the effect of collagenase incubation and air injection in endothelial cell viability. Collagenase in the same concentration as above was injected into the deep stroma. One hour and 15 minutes later, Descemet s membrane was separated from the stroma as described earlier. Subsequently, Descemet s membrane flat mounts were prepared by placing the air-separated Descemet s membrane, still attached to the stroma at the periphery, on a Barron s punch. An 8.5-mm Descemet s membrane piece was trephined from the digested stroma. Each isolated membrane was cut into four pieces with a razor blade to facilitate flattening the membrane. Small Descemet s membrane sections were placed for 2 minutes on a glass slide and 0.4% trypan blue solution in balanced salt solution, to evaluate cell viability. In the control group, corneas were sectioned in four pieces and stained with trypan blue. The percentage of dead cells was estimated by counting the percentage of blue-stained cells in a20 magnification in the areas that did not curl, avoiding the edge areas were the tissue was sectioned. Tissue Fixation and Sectioning and TUNEL Assay Corneal sections (7 m thick), after incubation for 75 minutes and air injection, were cut on a cryostat (HM 505M; Micron GmbH, Walldorf, Germany). Sections were placed on microscope slides (Superfrost Plus; Fisher Scientific, Pittsburgh, PA) and maintained at 85 C until staining was performed. To detect fragmentation of DNA associated with cell death, tissue sections were fixed in acetone at 20 C for 5 minutes, dried at room temperature for 5 minutes, and then placed in balanced salt solution. A fluorescence-based TUNEL assay was performed according to the manufacturer s instructions (ApopTag; Intergen Co, Purchase, NY). RESULTS A 2.5-mg/mL Collagenase Solution Facilitates Air Separation of Descemet s Membrane Time exposure to collagenase seemed to be an important factor in determining the success of separation. No separation
3 IOVS, December 2011, Vol. 52, No. 13 Descemet s Membrane Separation 9329 membrane in the air-injection group (Fig. 3A). Complete stroma Descemet s membrane separation was not noted at high magnification (Fig. 4B). In the collagenase-only group, light microscopy showed collagenolysis at low magnification (Fig. 3B) with no evident stroma Descemet s membrane separation. High magnification showed small clefts of separation at the stroma Descemet s membrane junction (Fig. 4C). In contrast, the collagenase air group showed evident Descemet s membrane separation (Figs. 3C). Areas suggestive of collagenolysis were evident at high magnification and a continuous separation cleft was noted (Fig. 4D). Anterior segment OCT was used to demonstrate the injection and location of collagenase in the stroma (Fig 5A) and the stroma Descemet s membrane separation after collagenase incubation for 75 minutes and air injection (Figs 5B, 5C). Electron microscopy further confirmed the separation of Descemet s membrane from the stroma. Figure 6 (right) shows a perfect separation between the corneal stroma and the anterior banded layer of Descemet s membrane. However, although light microscopy suggested perfect separation, in some higher magnification EM sections, stromal attachments to Descemet s membrane were noted (Fig. 6, left). FIGURE 2. Side view of the air bubble formed with stars delineating Descemet s membrane (A). Posterior view of the elevated Descemet s membrane and presence of air bubbles between the stroma and Descemet s membrane (B). was possible with either 25 or 100 minutes of incubation. Separation was successful in only one of three eyes after 50 minutes exposure, while complete separation was noted in three of three eyes after 75 minutes of exposure. A macroscopic examination in the collagenase air group showed complete Descemet s membrane separation (Fig. 2A, side view, and Fig. 2B, front view) in 15 eyes. The separation extended to the peripheral cornea in most of the eyes. Central separation was noted in only four. Air bubbles were noted between the Descemet s membrane and the stroma. Separation of Descemet s membrane was noted in only one eye of the air-only group and in none of the collagenase-only group (Table 1). Histologic Confirmation of Descemet s Membrane and Stroma Separation Histologic examination demonstrated normal corneal lamellae and the presence of air in the deep stroma close to Descemet s Cell Viability and TUNEL Assay Evaluation of three separated Descemet s flat mounts revealed excellent endothelial cell survival after collagenase digestion. The trypan blue exclusion test showed a mean cell viability of 87.7% (range, 82.1% 93.9%). Compared with a mean viability of 91.2% (86.5% 92.7%) in the control untreated group (P 0.1; not statistically significant; paired t-test [GraphPad, San Diego, CA]) (Fig.7A). To further explore the viability of the cells after collagenase incubation and air separation, a TUNEL assay was performed in three different eyes and further confirmed the excellent viability of the cells. It was surprising that no staining was noted in many sections studied, with very rare single-nuclei staining noted in 2 of 21 sections evaluated (Fig. 7B). Positive controls were run at the same time by an experienced laboratory investigator (Fig. 7C). DISCUSSION Corneal haze continues to be a limiting factor in achieving the best potential visual acuity after corneal procedures. It has been hypothesized, but not completely validated, that haze formation can be prevented or decreased in the case of lamellar corneal transplantation if the tissue interface is located between the stroma Descemet s membrane junction and not between the stroma stroma junction. However, confocal studies show that interface haze resolves over time. There also seems to be a stromal thickness effect with any irregularities in stromal thickness (as are inevitable with stromal dissection) that alters either the anterior surface contour in DALK or the posterior surface contour in DSEK, with increasing aberrations as a result. Early surgical techniques for Descemet s membrane separation from the corneal stroma during DMEK 1 4,8 have relied on the injection of air 12,13 or balanced saline solution, 14 the viscoelastic effect, 15 or just mechanical force. Similar to DALK, a hypothetical advantage of DMEK over DSEK is a better final TABLE 1. Summary of Methods Used for Separation Eyes, n Successful Descemet s Detachment, n (%) Histologic Appearance of Endothelial cells Air injection 5 1 (20) Normal, no endothelial cell damage Collagenase injection 5 0 (0) Normal, no endothelial cell damage Collagenase/air injection (83.3) Normal, no endothelial cell damage
4 9330 Espana et al. IOVS, December 2011, Vol. 52, No. 13 FIGURE 3. Hematoxylin eosin staining demonstrating attempted separation of Descemet s membrane. Air infiltration into the corneal stroma after air injection (A). Loss of corneal lamellae architecture was noted after injection of collagenase and incubation for 75 minutes (B). Collagenase injection followed by intrastromal air injection produced air infiltration and clear separation of Descemet s membrane (C). best corrected visual acuity due to less haze and scar formation if the interface is between Descemet s membrane and the stroma. We were unable to find the success rate of all experienced surgeons and centers in preparing Descemet s membrane grafts, to compare to our separation rate. Ignacio et al.1 reported a 100% success in peeling Descemet s membrane from stroma, whereas Busin et al.5 reported a 95% rate of success with pneumatic separation. The technique described in this article may increase the success rate of separation for the novice surgeon or eye bank technician preparing corneal tissue. Further work is needed to standardize the time and concentration of intrastromal collagenase. In our study, at least 1 hour and 15 minutes of collagenase incubation at room temperature was needed to allow air separation of Descemet s membrane. We do not know why collagenase did not perforate Descemet s membrane in any of the studied eyes or whether microperforations were present. It was difficult to determine whether air was also escaping into the anterior chamber, since FIGURE 4. Light microscopy evaluation of a cleavage plane after attempted separation of Descemet s membrane. Normal control showed no separation at the Descemet s membrane stroma junction (A). Injection of stromal air showed no separation of the junction (B). Collagenase digestion for 75 minutes created areas of cleavage at the junction (多) (C). Collagenase incubation followed by air injection produced a cleavage plane at the junction. Arrow: the beginning of the cleavage plane (D).
5 IOVS, December 2011, Vol. 52, No. 13 Descemet s Membrane Separation 9331 FIGURE 5. OCT confirmation of Descemet s membrane separation. A high-magnification image confirms the injection of collagenase into the stroma (A). A total Descemet s membrane detachment is imaged (B). A partial detachment is shown (C). after air injection there was no visualization of the anterior chamber. It is possible that in cases in which we were unable to separate Descemet s membrane from the stroma, unintended microperforations were created with the 27-gauge needle during collagenase injection into the stroma or possibly as a result of Descemet s membrane collagenolysis. Although the action of collagenase 2 is not specific against a specific collagen type, clinical observations show that Descemet s membrane is more resistant to perforation, as noted with infectious corneal ulcers where a Descemetocele is present. We could not separate Descemet s membrane from the deep stroma if the incubation time was either too short or too long. Our current hypothesis is that a short incubation time does not allow enough collagenolysis and cleavage of the Descemet s stroma junction. In contrast, longer exposure time (i.e., 100 minutes) may digest the anterior corneal stroma and allow air to leak through the anterior corneal surface. Once air leaks through the anterior corneal stroma, no pressure gradient is formed that forces Descemet s membrane posteriorly into the anterior chamber. We hypothesize that excessive anterior stromal digestion will not allow enough pressure gradient to form and force Descemet s membrane into the anterior chamber. Most likely, enzymatic activity will be enhanced at body temperature and a shorter incubation time will be needed if someday this method gains clinical application. Another intriguing finding was the difference in trypan blue staining and the almost absent TUNEL-positive cells found in histology sections. We ascribe this difference to the sensitivity of endothelial cells to manipulation during flat mount preparation. Descemet s membrane, as previously noted by many other investigators, tends to curl immediately after being separated from the stroma. Although the number of eyes studied with trypan blue was small, we believe that our technique does not cause any damage to endothelial cells, as shown by TUNEL assay and that the percentage of dead cells found with trypan blue in isolated membranes and in control eyes was mainly due to Descemet s membrane manipulation after isolation. Collagenase is a commonly used enzyme for the isolation of various cell types, including corneal epithelium and keratocytes, and does not need an inhibitor. Some of these isolation techniques require overnight incubation with collagenase. A great advantage of using collagenase is that once the stroma is separated from Descemet s membrane, the activity of collagenase becomes irrelevant. In the case of DMEK, once the membrane is isolated, placing it on balanced salt solution or preservation medium will inactivate the enzyme. In conclusion, we believe that our enzymatic technique would be a reliable technique for separating an intact Descemet s membrane for DMEK. This technique has the potential to be used for DALK, but several additional studies must be conducted. The use of collagenase in the recipient stroma as intended for DALK may be challenging due to collagenolysis in FIGURE 6. Illustrative electron photomicrograph showing the separation of stroma from Descemet s membrane after collagenase incubation and air injection. Left microphotograph shows a very thin layer of stroma attached to the inner layer of Descemet s membrane (A). Full separation with no stroma attached to Descemet s membrane (B).
6 9332 Espana et al. IOVS, December 2011, Vol. 52, No. 13 FIGURE 7. Cells remained viable after Descemet s separation. Trypan blue staining of an isolated flat mount at 20 magnification (A). TUNEL staining showed no nuclear staining in an isolated piece of Descemet s membrane. ( ) Area of separation from the stroma. DAPI-stained keratocyte nuclei can be seen (B). Positive control: TUNEL-stained apoptotic nuclei (red); DAPI-stained live nuclei (blue) (C). the recipient bed and the theoretical increased risk for keratoectasia. References 1. Ignacio TS, Nguyen TT, Sarayba MA, et al. A technique to harvest Descemet s membrane with viable endothelial cells for selective transplantation. Am J Ophthalmol. 2005;139: Tappin M. A method for true endothelial cell (Tencell) transplantation using a custom-made cannula for the treatment of endothelial cell failure. Eye (Lond). 2007;21: Lie JT, Birbal R, Ham L, et al. Donor tissue preparation for Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2008;34: Price MO, Giebel AW, Fairchild KM, Price FW Jr. Descemet s membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009;116: Busin M, Scorcia V, Patel AK, et al. Pneumatic dissection and storage of donor endothelial tissue for Descemet s membrane endothelial keratoplasty: a novel technique. Ophthalmology. 2010;117: Studeny P, Farkas A, Vokrojova M, et al. Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S). Br J Ophthalmol. 2010;94: McCauley MB, Price FW Jr, Price MO. Descemet membrane automated endothelial keratoplasty: hybrid technique combining DSAEK stability with DMEK visual results. J Cataract Refract Surg. 2009;35: Kruse FE, Laaser K, Cursiefen C, et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30: Hellstrom WJ. Medical management of Peyronie s disease. J Androl. 2009;30: Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase clostridium histolyticum for Dupuytren s contracture. N Engl J Med. 2009;361: Zhang P, Qin L. Injectable collagenase clostridium histolyticum for Dupuytren s contracture. N Engl J Med. 2009;361: Anwar M, Teichmann KD. Big-bubble technique to bare Descemet s membrane in anterior lamellar keratoplasty. J Cataract Refract Surg. 2002;28: Archila EA. Deep lamellar keratoplasty dissection of host tissue with intrastromal air injection. Cornea. 1984;3: Sugita J, Kondo J. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement. Br J Ophthalmol. 1997;81: Manche EE, Holland GN, Maloney RK. Deep lamellar keratoplasty using viscoelastic dissection. Arch Ophthalmol. 1999;117:
Descemet s Stripping Endothelial Keratoplasty (DSEK)
Descemet s Stripping Endothelial Keratoplasty (DSEK) Your doctor has decided that you will benefit from a corneal transplant operation. This handout will explain your options to you. It explains the differences
More informationDescemet s Stripping Automated Endothelial Keratoplasty (DSAEK)
Descemet s Stripping Automated Endothelial Keratoplasty (DSAEK) John D. Goosey, MD Introduction DSAEK is a corneal transplant technique where the unhealthy, diseased, posterior portion of a patient s cornea
More informationKensington Eye Center 4701 Randolph Road, #G-2 Rockville, MD 20852 (301) 881-5701 www.keceyes.com
Kensington Eye Center 4701 Randolph Road, #G-2 Rockville, MD 20852 (301) 881-5701 www.keceyes.com Natasha L. Herz, MD INFORMED CONSENT FOR DESCEMET S STRIPPING and AUTOMATED ENDOTHELIAL KERATOPLASTY (DSAEK)
More informationCONSENT FORM. Procedure: Descemet s Stripping Automated Endothelial Keratoplasty (DSAEK)
CONSENT FORM Procedure: Descemet s Stripping Automated Endothelial Keratoplasty (DSAEK) Surgeon: Jeffrey W. Liu, M.D. Peninsula Laser Eye Medical Group 1174 Castro Street, Ste. 100 Mountain View, CA 94040
More informationUltrathin DSAEK Tissue Prepared With a Low Pulse Energy, High-Frequency Femtosecond Laser
BASIC INVESTIGATION Ultrathin DSAEK Tissue Prepared With a Low Pulse Energy, High-Frequency Femtosecond Laser Paul M. Phillips, MD,* Louis J. Phillips, OD,* Hisham A. Saad, MD, Mark A. Terry, MD, Donna
More informationNew and Improved Femtosecond Laser Applications. Karl Stonecipher, MD Wavefront Congress 2008
New and Improved Femtosecond Laser Applications Karl Stonecipher, MD Wavefront Congress 2008 When birds don t fly, neither should you. When cows bunch together in a field, a storm is coming. When ants
More informationOverview of Refractive Surgery
Overview of Refractive Surgery Michael N. Wiggins, MD Assistant Professor, College of Health Related Professions and College of Medicine, Department of Ophthalmology Jones Eye Institute University of Arkansas
More informationCorporate Medical Policy Implantation of Intrastromal Corneal Ring Segments
Corporate Medical Policy Implantation of Intrastromal Corneal Ring Segments File Name: Origination: Last CAP Review: Next CAP Review: Last Review: implantation_of_intrastromal_corneal_ring_segments 8/2008
More informationPost LASIK Ectasia. Examination: Gina M. Rogers, MD and Kenneth M. Goins, MD
Post LASIK Ectasia Gina M. Rogers, MD and Kenneth M. Goins, MD October 6, 2012 Chief Complaint: Decreasing vision after laser- assisted in- situ keratomileusis (LASIK) History of Present Illness: This
More informationThe «three-in-one» Microkeratome for traditional LASIK, EPI-LASIK, and anterior and posterior Lamellar Keratoplasty
The «three-in-one» Microkeratome for traditional LASIK, EPI-LASIK, and anterior and posterior Lamellar Keratoplasty Ziemer Group We develop and produce diagnostic and surgical products for the ophthalmic
More informationNEW HORIZONS IN CORNEAL SURGERY VERSATILE FEMTOSECOND LASER WORKSTATION WE FOCUS ON PERFECTION
NEW HORIZONS VERSATILE FEMTOSECOND IN CORNEAL LASER WORKSTATION SURGERY WE FOCUS ON PERFECTION ADVANCED FEMTOSECOND LASER TECHNOLOGY COMMITTED TO VERSATILITY > ONE SYSTEM FOR ALL FEMTO-APPLICATIONS > ANATOMICALLY
More informationFemto-LASIK. Pulsewidth: Ultrashort-pulse micro- machining can make sub- wavelength holes. micromachining
All-laser laser LASIK (Femto( Femto-LASIK) Femto-LASIK 台 大 眼 科 王 一 中 IntraLase 2/1 Perfect Vision Ziemer (DaVinci) Carl Zeiss Meditec Pulsewidth: Femtosecond laser (Nd:Glass)) 153 nm (near infrared) Each
More informationCall today at 1 877 702 2020
Call today at 1 877 702 2020 VISIAN ICL LASIK is a well known, successful, and accurate laser vision correction procedure which has been FDA approved in the U.S. for 15 years. The majority of patients
More informationCornea and Refractive Surgery Update
Cornea and Refractive Surgery Update Fall 2015 Optometric Education Dinner Sebastian Lesniak MD Matossian Eye Associates Disclosures: None Bio: Anterior Segment and Cornea Surgery Fellowship Wills Eye
More informationMedical Director, Shinagawa LASIK Center, Tokyo, Japan Adjunct Professor, Department of Ophthalmology, Wenzhou Medical College, Wenzhou, China
Medical Director,, Tokyo, Japan Adjunct Professor, Department of Ophthalmology, Wenzhou Medical College, Wenzhou, China Financial disclosure: Ziemer Group AG, Switzerland AcuFocus, CA Schwind Eye-Tech-Solutions,
More informationISOLATION AND PROPERTIES OF SECRETORY GRANULES FROM RAT ISLETS OF LANGERHANS. II. Ultrastructure of the Beta Granule
ISOLATION AND PROPERTIES OF SECRETORY GRANULES FROM RAT ISLETS OF LANGERHANS II Ultrastructure of the Beta Granule MARIE H GREIDER, S L HOWELL, and P E LACY From the Department of Pathology, Washington
More informationDescemet s stripping with endothelial keratoplasty in 200 eyes
J CATARACT REFRACT SURG - VOL 32, MARCH 2006 Descemet s stripping with endothelial keratoplasty in 200 eyes Early challenges and techniques to enhance donor adherence Francis W. Price Jr, MD, Marianne
More informationRefractive Surgery. Evolution of Refractive Error Correction
Refractive Surgery Techniques that correct for refractive error in the eye have undergone dramatic evolution. The cornea is the easiest place to place a correction, so most techniques have focused on modifying
More informationVisiting Your Doctor
Visiting Your Doctor Legal Disclaimer The information in this booklet is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical
More informationCLINICAL SCIENCE. Conclusion: Postoperative results of DSAEK using donor tissue excluded from use in penetrating keratoplasty as a result of stromal
CLINICAL SCIENCE Descemet s Stripping Automated Endothelial Keratoplasty (DSAEK) Using Corneal Donor Tissue Not Acceptable for Use in Penetrating Keratoplasty as a Result of Anterior Stromal Scars, Pterygia,
More informationCurtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State
Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State University Columbus, Ohio Refractive Errors Myopia (nearsightedness)
More informationDuckworth & Kent Ophthalmic Titanium Surgical Instruments
Duckworth & Kent Ophthalmic Titanium Surgical Instruments at the Leading Edge LASIK Instruments Duckworth and Kent is the first and original manufacturer and supplier of titanium surgical instruments.
More informationKeratoconus. Progressive bilateral ectasia. Onset puberty. Prevalence 1:2000. 20% progress to transplantation. Pathogenesis unclear
Keratoconus Progressive bilateral ectasia Onset puberty Prevalence 1:2000 20% progress to transplantation Pathogenesis unclear Increased pepsin and catalase Decreased collagen crosslinking cf normal Conventional
More informationprotocol handbook 3D cell culture mimsys G hydrogel
handbook 3D cell culture mimsys G hydrogel supporting real discovery handbook Index 01 Cell encapsulation in hydrogels 02 Cell viability by MTS assay 03 Live/Dead assay to assess cell viability 04 Fluorescent
More informationMinimally Invasive Surgery: Femtosecond Lasers and Other Innovative Microsurgical Techniques
Minimally Invasive Surgery: Femtosecond Lasers and Other Innovative Microsurgical Techniques Julio Narváez MD Associate Professor of Ophthalmology Loma Linda University Non-Refractive Applications of Femtosecond
More informationVISION PATTERN. What Can you Expect from the ReSTOR procedure?
RESTOR Presbyopia is the normal aging process that everyone experiences over the age of 40 which affects near vision. This usually results in the need for reading glasses or bifocals. The crystalline lens
More information2013 EYE BANKING STATISTICAL REPORT
2013 EYE BANKING STATISTICAL REPORT Eye Bank Association of America 1015 18th Street, N.W. Suite 1010 Washington, DC 20036 Phone (202) 775-4999 www.restoresight.org 2014. EBAA. All rights reserved Table
More informationOCT-guided Femtosecond Laser for LASIK and Presbyopia Treatment
Shinagawa LASIK Center OCT-guided Femtosecond Laser for LASIK and Presbyopia Treatment Minoru Tomita, MD, Ph.D 1) Executive Medical Director at Shinagawa LASIK Center, Tokyo, Japan 2) Clinical Professor
More informationLABORATORY SCIENCES. Confocal Microscopy of Corneal Wound Healing After Deep Lamellar Keratoplasty in Rabbits
LABORATORY SCIENCES Confocal Microscopy of Corneal Wound Healing After Deep Lamellar Keratoplasty in Rabbits Almamoun Abdelkader, MD, PhD; El-Sayed M. Elewah, MD, PhD; Herbert E. Kaufman, MD Objective:
More informationLASIK. Complications. Customized Ablations. Photorefractive Keratectomy. Femtosecond Keratome for LASIK. Cornea Resculpted
Refractive Surgery: Which Procedure for Which Patient? David R. Hardten, M.D. Minneapolis, Minnesota Have done research, consulting, or speaking for: Alcon, Allergan, AMO, Bausch & Lomb, Inspire, Medtronic,
More informationFinancial Disclosure. LASIK Flap Parameters IntraLase Microkeratome 6/9/2008. Femtosecond LASIK Flaps: What Could We Customize Yesterday?
Financial Disclosure Arturo Chayet, MD Tijuana, BC Mexico Perry S. Binder, MS, MD San Diego CA USA I have the following financial interests or relationships to disclose: AMO/IntraLase Corporation - C Acufocus
More informationREFRACTIVE SURGERY NIGHTMARES Dr.ATHIYA AGARWAL
REFRACTIVE SURGERY NIGHTMARES Dr.ATHIYA AGARWAL POST LASIK INFECTION Infection occurring after photorefractive keratectomy (PRK) may be 1. Secondary to the defect in the epithelium as well as the use of
More informationSome of the ophthalmic surgeries performed at the DMV Center.
Some of the ophthalmic surgeries performed at the DMV Center. This document presents some types of the surgeries performed by the ophthalmology service at the DMV veterinary center as well as the equipment
More informationMedicare and Corneal Surgery: Cosmetic versus Functional
Medicare and Corneal Surgery: Cosmetic versus Functional Riva Lee Asbell INTRODUCTION With the introduction of several new CPT (Current Procedural Terminology) codes for cornea, corneal coding is in the
More informationMoria Range of Products
Moria Range of Products LASIK Epi-LASIK Corneal Transplant Evolution 3E LASIK Intelligently designed Safety and reliability of two independent motors: one for head advancement, one for blade oscillation.
More informationEndothelial Keratoplasty
Endothelial Keratoplasty A Simplified Technique to Minimize Graft Dislocation, Iatrogenic Graft Failure, and Pupillary Block Mark A. Terry, MD, 1,2 Neda Shamie, MD, 1 Edwin S. Chen, MD, 1 Karen L. Hoar,
More informationTransepithelial Crosslinking vs. Corneal Pocket Crosslinking. Christoph Kranemann MD Anna Yu OD
Transepithelial Crosslinking vs. Corneal Pocket Crosslinking Christoph Kranemann MD Anna Yu OD Rome 2013 We have no financial interests in this presentation. Corneal collagen cross linking Creates new
More informationThe Nurse/Technician Role Within the Emerging Ophthalmic Technology - OCTs/B-Scan
The Nurse/Technician Role Within the Emerging Ophthalmic Technology - OCTs/B-Scan Margie V. Wilson, COMT Chief Clinical Supervisor UCSD Shiley Eye Center Thanks, Carol! Unfortunately. I have not financial
More informationRichard S. Hoffman, MD. Clinical Associate Professor of Ophthalmology Oregon Health & Science University
Zeiss Mel 80 and Visumax Refractive Laser Systems Richard S. Hoffman, MD Clinical Associate Professor of Ophthalmology Oregon Health & Science University No Financial Interest ZEISS Workstation CRS-Master
More informationDua s Layer: its discovery, characteristics and applications
UPDATE/REVIEW Dua s Layer: its discovery, characteristics and applications Harminder S. Dua, BBS, DO, DO (Lond), MS, MNAMS, FRCS, FRCOphth., FEBO, MD, PhD 1 ; Lana A. Faraj, MD, MSc 1 ; Dalia G. Said,
More informationMAZAHERI LASIK METHOD FOR VISUAL ENHANCEMENT TECHNICAL FIELD OF THE INVENTION. [0001] The present invention is directed, in general, to
MAZAHERI LASIK METHOD FOR VISUAL ENHANCEMENT TECHNICAL FIELD OF THE INVENTION [0001] The present invention is directed, in general, to a surgical procedure and, more particularly, to surgical procedure
More informationThe American Journal of Ophthalmology
The American Journal of phthalmology Copy of e-mail Notification zrx6952 Proofs of The American Journal of phthalmology Article (# 6256) ===== Dear Author: The proof of your article to be published by
More informationTABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM
1 BoydVision TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM Risks and Side Effects... 2 Risks Specific to PRK... 3 Risks Specific to LASIK... 4 Patient Statement of Consent... 5 Consent for Laser Eye
More informationFemtosecond Lasers in LASIK Surgery
Femtosecond Lasers in LASIK Surgery Dr Chan Tat Keong Senior Consultant Refractive Surgery Service Singapore National Eye Centre Disclosure Speaker has no financial interest in the products to be discussed
More informationManagement of Epithelial Ingrowth after LASIK. Helen K. Wu, MD New England Eye Center Tufts University School of Medicine Boston, MA
Management of Epithelial Ingrowth after LASIK Helen K. Wu, MD New England Eye Center Tufts University School of Medicine Boston, MA Acknowledgements IOP Ophthalmics Staar Surgical Case Presentation 46
More informationfemtosecond laser platform Exceptional versatility without compromise
Introducing the VICTUS femtosecond laser platform Exceptional versatility without compromise FEMTOSECOND TECHNOLOGY that empowers Introducing VICTUS the first femtosecond laser capable of exceptional performance
More informationComparison to other anterior segment imaging devices
found helpful in a number of areas of ophthalmology. However, in the field of anterior segment tumors its usefulness is confined to a subset of tumors that are confined to the iris, hypo pigmented, and
More informationCollagen cross-linking should be done separately. Canan Asli Utine, MD, MSc, FICO Yeditepe University, Istanbul, Turkey
Collagen cross-linking should be done separately Canan Asli Utine, MD, MSc, FICO Yeditepe University, Istanbul, Turkey Collagen cross linking 1st established tx addressing the pathophysiology of corneal
More informationKeratoconus Lasers, Lenses & Boomerangs (the journey, missing links, and management & treatment options) Moderator: Jan P G Bergmanson, OD, PhD
2014 AAO CCLRT Section Symposium Keratoconus Lasers, Lenses & Boomerangs (the journey, missing links, and management & treatment options) Moderator: Jan P G Bergmanson, OD, PhD Recurrent Keratoconus: Does
More informationTHE EYES IN MARFAN SYNDROME
THE EYES IN MARFAN SYNDROME Marfan syndrome and some related disorders can affect the eyes in many ways, causing dislocated lenses and other eye problems that can affect your sight. Except for dislocated
More informationApplications in Dermatology, Dentistry and LASIK Eye Surgery using LASERs
Applications in Dermatology, Dentistry and LASIK Eye Surgery using LASERs http://www.medispainstitute.com/menu_laser_tattoo.html http://www.life123.com/bm.pix/bigstockphoto_close_up_of_eye_surgery_catar_2264267.s600x600.jpg
More informationReLEx smile Minimally invasive vision correction Information for patients
ReLEx smile Minimally invasive vision correction Information for patients Seeing is living Our eyes are our most important sensory organ. The human brain obtains over 80 % of its information via the sense
More informationSurface Ablation After Corneal
Surface Ablation After Corneal Surgery: Management of Haze Helen K. Wu, MD New England Eye Center Tufts University School of Medicine Boston, MA Financial Disclosures Travel Stipend/Honoraries: IOP Ophthalmics
More informationFIRST EXPERIENCE WITH THE ZEISS FEMTOSECOND SYSTEM IN CONJUNC- TION WITH THE MEL 80 IN THE US
FIRST EXPERIENCE WITH THE ZEISS FEMTOSECOND SYSTEM IN CONJUNC- TION WITH THE MEL 80 IN THE US JON DISHLER, MD DENVER, COLORADO, USA INTRODUCTION AND STUDY OBJECTIVES This article summarizes the first US
More informationINTRACOR. An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the
INTRACOR An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the 1 Dr Luis Ruiz Presbyopia treatment with INTRACOR Luis
More informationCONSENT FOR CATARACT SURGERY REQUEST FOR SURGICAL OPERATION / PROCEDURE AND ANAESTHETIC
CONSENT FOR CATARACT SURGERY REQUEST FOR SURGICAL OPERATION / PROCEDURE AND ANAESTHETIC Your doctor has indicated that the condition of your eye appears stable and your cataract surgery and/or implantation
More informationIntraLase and LASIK: Risks and Complications
No surgery is without risks and possible complications and LASIK is no different in that respect. At Trusted LASIK Surgeons, we believe patients can minimize these risks by selecting a highly qualified
More informationEye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology
Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology INDICATIONS AND PROCEDURE This information is being provided to
More informationRisks and Limitations of LASIK Procedure
Drs. Fine, Hoffman & Packer, LLC 1550 Oak Street, Suite #5 Eugene, OR 97401 541-687-2110 From Drs. Fine, Hoffman, & Packer Risks and Limitations of LASIK Procedure Infection, serious injury, or even death,
More informationTotal Corneal Astigmatism Correction With Limbal Relaxing Incisions Made by Femtosecond Laser System
Total Corneal Astigmatism Correction With Limbal Relaxing Incisions Made by Femtosecond Laser System Pilavas J 2, Nissirios N 1,2, Hatsis A 1,2 1 Long Island Vision Experts, Rockville Centre, NY and 2
More informationHow To Implant A Keraring
Corneal Remodeling Using the Keraring A variety of thicknesses, arc lengths, and optical zone sizes allows tailoring of the procedure to the individual patient. BY DOMINIQUE PIETRINI, MD; AND TONY GUEDJ
More informationVIS T E C H N O L O G I E S. Technology Presentation www.ivistechnologies.com. A 2009 OSEO-Certified Innovative Enterprise
VIS T E C H N O L O G I E S Technology Presentation www.ivistechnologies.com A 2009 OSEO-Certified Innovative Enterprise ivis Milestones 1993 - ivis Technologies began its extensive R&D program into the
More informationNew topographic custom ablation procedure for treating irregular astigmatism post keratoplasty with high frequency (1 KHz) excimer laser.
New topographic custom ablation procedure for treating irregular astigmatism post keratoplasty with high frequency (1 KHz) excimer laser. G. COLONNA M.D., G. Lorusso M.D., S. Santoro M.D. ESCRS Berlin
More informationManaging Post-Operative Complications for LASIK and PRK
Managing Post-Operative Complications for LASIK and PRK LASIK Flap Complications Epithelial defects o Cause Basement membrane dystrophy Recurrent erosion syndrome Dry eyes Trauma PRK as alternative Pre-treat
More informationINFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)
Lasik Center 2445 Broadway Quincy, IL 62301 217-222-8800 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION This information is being provided to you so that you can make an informed
More informationALTERNATIVES TO LASIK
EYE PHYSICIANS OF NORTH HOUSTON 845 FM 1960 WEST, SUITE 101, Houston, TX 77090 Office: 281 893 1760 Fax: 281 893 4037 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION This information
More informationTECHNICAL GUIDELINES FOR OCULAR TISSUE *
Page 1 of 9 TECHNICAL GUIDELINES FOR OCULAR TISSUE * GENERAL. The following Guidelines take into account the following Directives, mandatory in those countries which belong to the European Union : Directive
More informationOphthalmology ROUNDS. Advances in Corneal Transplantation. Department of Ophthalmology and Vision Sciences
NOVEMBER/DECEMBER 2006 Volume 4, Issue 6 Ophthalmology ROUNDS AS PRESENTED IN THE ROUNDS OF THE DEPARTMENT OF OPHTHALMOLOGY AND VISION SCIENCES, FACULTY OF MEDICINE, UNIVERSITY OF TORONTO Advances in Corneal
More informationDeep Anterior Lamellar Keratoplasty as an Alternative to Penetrating Keratoplasty
Ophthalmic Technology Assessment Deep Anterior Lamellar Keratoplasty as an Alternative to Penetrating Keratoplasty A Report by the American Academy of Ophthalmology William J. Reinhart, MD, 1 David C.
More informationCorneal intrastromal implantation surgery for the treatment of moderate and high myopia
TECHNIQUE Corneal intrastromal implantation surgery for the treatment of moderate and high myopia Albert Daxer, MD, PhD I describe a corneal intrastromal implantation technique that uses a new type of
More informationForeword. Richard Troutman, MD, DSc (Hon), FACS, FRCOphth
Foreword Richard Troutman, MD, DSc (Hon), FACS, FRCOphth I would like to congratulate Dr Gaster for having assembled this comprehensive collection of papers on Recent Advances in Cornea, External Disease
More informationLong-Term Outcomes of Flap Amputation After LASIK
Long-Term Outcomes of Flap Amputation After LASIK Priyanka Chhadva BS, Florence Cabot MD, Anat Galor MD, Sonia H. Yoo MD Bascom Palmer Eye Institute, University of Miami Miller School of Medicine Miami
More informationINFORMED CONSENT FOR LASIK SURGERY
IMPORTANT: READ EVERY WORD! This information is to help you make an informed decision about having laser assisted in-situ keratomileusis (LASIK) surgery to treat your nearsightedness, farsightedness and/or
More informationΔιαθλαζηικη Χειροσργικη 2014
Διαθλαζηικη Χειροσργικη 2014 Επιθηλιο Femto Κεραηοκωνος Διαζσνδεζη Κολλαγονοσ Anastasios John Kanellopoulos, MD Professor: NYU Medical School, New York, NY LaserVision.gr Eye Institute, Athens, Greece
More informationAnterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery
Anterior Lamellar Keratoplasty With a Microkeratome: A Method for Managing Complications After Refractive Surgery Farhad Hafezi, MD; Michael Mrochen, PhD; Franz Fankhauser II, MD; Theo Seiler, MD, PhD
More informationComplications of Combined Topography-Guided Photorefractive Keratectomy and Corneal Collagen Crosslinking in Keratoconus
Complications of Combined Topography-Guided Photorefractive Keratectomy and Corneal Collagen Crosslinking in Keratoconus Michelle Cho, M.D. 1 Anastasios John Kanellopoulos, M.D 1,2 New York University
More informationOphthalmology Department,Tanta University, Egypt
Moataz M. Sabry, MD, PhD. Ophthalmology Department,Tanta University, Egypt 1 SHOULD WE ABONDONE MECHANICAL MICROKERATOMES? 2 With Mechanical, LASIK is a one-laser procedure, there s no moving of patient
More informationPROTOCOL. Immunocytochemistry (ICC) MATERIALS AND EQUIPMENT REQUIRED
PROTOCOL Immunocytochemistry (ICC) 1850 Millrace Drive, Suite 3A Eugene, Oregon 97403 11-07 MATERIALS AND EQUIPMENT REQUIRED Materials: MitoSciences primary monoclonal antibody/antibodies Fluorophore-conjugated
More informationJAMES S. LEWIS, MD. James S. Lewis, MD. Curriculum Vitae Certification: American Board of Ophthalmology, 1989 Affiliation: Wills Eye Surgical Network
Ophthalmologist JAMES S. LEWIS, MD CATARACT AND GLAUCOMA SURGEON CORNEA AND LASIK SPECIALIST James S. Lewis, MD 215.886.9090 8380 Old York Road Suite 110A Elkins Park, PA 19027 jslewis@jameslewismd.com
More informationOCT-based IOL power calculation for eyes with previous myopic and hyperopic laser vision correction
American Academy of Ophthalmology Annual Meeting Orlando, Florida, 21-25 October 2011 OCT-based IOL power calculation for eyes with previous myopic and hyperopic laser vision correction Weeks Professor
More informationINFORMED CONSENT TO HAVE LASIK
A Division of Scott & Christie and Associates INFORMED CONSENT TO HAVE LASIK This information is to help you make an informed decision about having Laser Assisted Intrastromal Keratomileusis (LASIK), an
More informationMaximizing Your Cataract Surgery Outcomes in Corneal Disease
Maximizing Your Cataract Surgery Outcomes in Corneal Disease W. Barry Lee, M.D., F.A.C.S. Cornea & Refractive Surgery Eye Consultants of Atlanta Piedmont Hospital Co-Medical Director Georgia Eye Bank Atlanta,
More informationCorneal Transplant Surgery A Guide for Patients
Corneal Transplant Surgery A Guide for Patients Table of Contents Introduction... 1 What Is Corneal Transplant Surgery?... 2 The Donor Cornea... 3 The Surgery... 4 After Surgery... 5 Graft Rejection...
More informationRELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY
RELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY DR SANDIP MITRA MD FRCS CORNEA AND REFRACTIVE FELLOW (ROYAL VICTORIA EYE AND EAR HOSPITAL, AUSTRALIA) RELEX SMILE UNIT AT THE ALZAHRA
More informationA Microscopy Study of the Structural Features of Post- LASIK Human Corneas
A Microscopy Study of the Structural Features of Post- LASIK Human Corneas Mohammad Abahussin 1,2, Sally Hayes 1, Henry Edelhauser 3, Daniel G. Dawson 3,4, Keith M. Meek 1 * 1 Structural Biophysics Research
More informationINFORMED CONSENT FOR LASER ASSISTED SUBEPITHELIAL KERATOMILEUSIS (LASEK)/PHOTO-REFRACTIVE KERATECTOMY (PRK)
INFORMED CONSENT FOR LASER ASSISTED SUBEPITHELIAL KERATOMILEUSIS (LASEK)/PHOTO-REFRACTIVE KERATECTOMY (PRK) Please read the following consent form very carefully. Please initial each page where indicated.
More informationINFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE TECHNOLOGY
EYE PHYSICIANS OF NORTH HOUSTON 845 FM 1960 WEST, SUITE 101, Houston, TX 77090 Office: 281 893 1760 Fax: 281 893 4037 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE
More informationTechnical specifications. TECHNOLAS Femtosecond Workstation 520F Versatility at its best. Diode Pumped Solid State Laser (DPSSL)
Technical specifications Laser type Pulse duration Wavelength Pulse frequency Supply Power consumption Size Weight System Components Microscope Safety Room conditions Diode Pumped Solid State Laser (DPSSL)
More information(Mazzotta et al, 2007) Human corneal rigidity increases 329 % (Wollensak, 2006)
Simultaneous PRK and CXL Corneal Crosslinking (CXL): UV-A light, 365 nm, causes riboflavin, 0.1 %, to release oxygen radicals which create new cross-linking bonds between collagen lameller fibres and within
More informationShort and long term complications of combined. Protocol) in 412 keratoconus eyes (2 7 years follow up)
Short and long term complications of combined topography guided PRK and CXL (the Athens Protocol) in 412 keratoconus eyes (2 7 years follow up) Anastasios John Kanellopoulos, MD Director, Laservision.gr
More informationMAke A difference in someone s life
MAke A difference in someone s life Fitting guide En del av Multilens contents Introduction 1 Applications 2 characteristics 2 Fitting philosophy 3 Fitting process 4 Ideal fit 5 Comfort vs lens awarness
More informationSurgical Advances in Keratoconus. Keratoconus. Innovations in Ophthalmology. New Surgical Advances. Diagnosis of Keratoconus. Scheimpflug imaging
Surgical Advances in Keratoconus Keratoconus Ectatic disorder 1 in 1,000 individuals Starts in adolescence & early adulthood Uncertain cause 20% require corneal transplant Innovations in Ophthalmology
More informationBascom Palmer Eye Institute. LASIK and Your Vision Correction
Bascom Palmer Eye Institute LASIK and Your Vision Correction For Many Patients, the Wait is Over The Vision Correction Center at Bascom Palmer For many patients who want to see near, far and everywhere
More informationVision Correction Surgery Patient Information
Vision Correction Surgery Patient Information Anatomy of the eye: The eye is a complex organ composed of many parts, and normal vision requires these parts to work together. When a person looks at an object,
More informationRefractive Surgery Ring segments still valuable for keratoconus treatment
Refractive Surgery Ring segments still valuable for keratoconus treatment by Michelle Dalton EyeWorld Contributing Editor AT A GLANCE Intrastromal ring segments can stabilize the keratoconic cornea up
More information5/24/2013 ESOIRS 2013. Moderator: Alaa Ghaith, MD. Faculty: Ahmed El Masri, MD Mohamed Shafik, MD Mohamed El Kateb, MD
ESOIRS 2013 Moderator: Alaa Ghaith, MD Faculty: Ahmed El Masri, MD Mohamed Shafik, MD Mohamed El Kateb, MD 1 A systematic approach to the management of Keratoconus through the presentation of different
More informationInformation and consent for patients preparing for refractive surgery LASIK Laser Eye Center Kubati
1. General information Not long ago, the WHO - World Health Organization has described ametropy (medical term for diopter) as a category of disability creating a solution to the needs of many with ametropy
More informationIncision along Steep Axis
Toric IOL An option or a must? ~ 15% cataract surgical patients >1.5 D Options: spectacles, CLs, Incision along steep axis, LRI, AK, toric IOL, Excimer Laser or a combination Walter J. Stark, MD Professor
More informationNational Medical Policy
National Medical Policy Subject: Policy Number: Endothelial Keratoplasty NMP534 Effective Date*: June 2014 Updated: June 2015 This National Medical Policy is subject to the terms in the IMPORTANT NOTICE
More informationCataract Testing. What a Patient undergoes prior to surgery
Cataract Testing What a Patient undergoes prior to surgery FINANCIAL DISCLOSURE I have no financial interest or relationships to disclose What do most Technicians find to be the most mundane yet very important
More information