Laser Thermokeratoplasty or LTK is one more form of laser eye surgery. It is used to treat astigmatisms and farsightedness. The laser beam is used to shrink and reshape the cornea using laser beams. Astigmatisms, and farsightedness can be corrected in seconds with no incision and no removal of any tissue.

This technique is good but is only effective in the short-term. The surgery begins to regress following LTK eye surgery. The surgeon will often overcorrect the vision problem to allow for regression. Regression may not be found immediately, it could be as long as ten years. LTK is still classified as a temporary or nonpermanent.

Laser Thermokeratoplasty has certain advantages that are important to know. Because it is a laser therapy using only a small beam of heat, there is little or no risk of infection or any vision loss. The risk of infection is nonexistent because no instruments touch the eye, only the laser beam. Another advantage of LTK surgery is that is done quickly. There is only a mild discomfort and most patients can resume their normal activities the next day.

There are some disadvantages of LTK surgery just as there is with any surgery. We already touched on the fact that it is not a permanent solution. Some vision problems occur after surgery because of the need to overcorrect the problem to compensate for regression. Glasses may be needed for a few weeks after surgery. Patients who have LTK surgery may lose some of the benefits of the corrective surgery within three months. On rare occasions, a patient may lose the corrective effects ten years after surgery. LTK laser surgery is recommended for people over the age of 40 who are only mildly farsighted.

Side effects are slight but will still occur. You may feel a sensitivity to light, and you may feel as if you have a speck of dust in your eye. Normally these two side effects go away after a day or two and can be treated with prescription eye drops.

How do you know if you are qualified for LTK eye surgery? Because it is considered nonpermanent, patients under the age of 40 are not recommended to have this surgery. The other qualifications for LTK are the same as any refractive surgery.

If you are planning on having LTK eye surgery there are steps you should take to prepare yourself for this surgery. You will be asked to undergo tests to see how thick your cornea is, what amount of refraction you have, and how well your pupil dilates. After these tests are completed, you will meet with the surgeon and set the date for the procedure. Write down any specific questions you may want to ask your surgeon. Surgery is done as an outpatient procedure but you will want to plan for transportation after your surgery is complete. Be sure to eat a light meal before you go in for the procedure and take all of your prescribed medicines so your doctor can be sure there will be no drug interactions.

Nearly 2/3 of the eye is made of a clear gel-like substance that fills the center of the eye.  When problems arise and affect the back of the eye a vitrectomy, a removal of the vitreous.  After this is done the vitreous builds back up as the eye secretes aqueous and nutritive fluids.  This procedure may also be done to clear blood and other debris from the eye.  It can be used to remove scar tissue.  Anything that has collected in the vitreous can obscure light as it passes through the eye on its way to the retina and result in blurred vision.

Some other common conditions that may need a vitrectomy are:

·        Problems related to an earlier surgery

·        Injury or infection

·        Pre-retinal membrane fibrosis

·        Hemorrhaging in the eye

·        Retinal detachment

·        Macular hole

·        Complications from diabetic retinopathy

A microscope is used for the procedure with a special lens that gives the surgeon give a clear image of the back of the eye.  Tiny surgical instruments are placed in several tiny incisions to light up the inside the eye, keep the eye’s shape during surgery and microsurgical instruments to cut and remove the vitreous liquid.

This procedure may also be used with retinal detachment repair, macular hole surgery, and macular membrane peel.  The length of vitrectomy surgery depends on what procedures are being done with the vitrectomy.

Special treatments may also be performed during a vitrectomy procedure.  Tiny blood vessels may be sealed off with a laser beam because of bleeding.  Gas bubbles may be used to help heal a macular hole and silicone oil may be used to keep the retina in the correct position.

A patient can expect to have a patch covering the eye that was worked on until the eye is able to blink normally.  Once the patch is removed, eye drops must be used.  If the area swells, ice compresses can be placed on the area.  Take Tylenol for aching and soreness.  A good eye compress is a bag of frozen vegetables.  They conform easily to the shape they are placed on and can be used more than once.  If you have soreness and pain that cannot be relieved by Tylenol or other over-the-counter pain reliever, you need to contact your surgeon.  It is common to experience redness in and around the affected eye and a look of bruising near the corner of the eye.

After the surgery you will need to use antibiotic and anti-inflammatory drops immediately after you take the patch off.  You will also need to wear a plastic eye shield when sleeping for seven days after surgery.  Once you have had the procedure, you will not be able to lift over five pounds and you must avoid bending and stooping.  You will need to apply ice compresses and ask the doctor if there are any precautions of where you place your head during recovery.

Recovery from this procedure will vary from patient to patient and will depend on what is done during the surgery.  As with all surgeries there is always a risk involved.  Please ask your doctor any questions or concerns that you have before the surgery.

Before talking about the surgery an explanation of vitreoretinal eye surgery and the parts of the eye affected is important.

Vitreoretinal eye surgery is the surgery that alleviates problems such as retinal detachment and intraocular infection (an infection inside the eye). These problems affect the retina and vitreous within the eye.

What is the retina?

The retina is a thin layer of neural cells that is an outgrowth of the developing brain, along with the optic nerve it is found at the back of the eye.

The retina is part of the central nervous system and its primary responsibility is to produce the images we “see” through retinal receptors, rods and cones that show patterned excitation depending on the image received. This information is sent to the different parts of the brain that form a representation of what we understand we are seeing.

What is the Vitreous?

Vitreous, known as vitreous humor, is a clear liquid very much the same in texture as the white of an egg. The vitreous is found in the eye between the lens and the retina and has a dual function, first the vitreous must not impede the light travelling into the eye so the best possible vision is achieved while secondarily, providing cushioned support to the eye.

Vitrectomy eye surgery

The vitrectomy surgery was the brainchild of Robert Machemer in 1970 and is the surgical operation to remove vitreous humor from the eye. Since its creation the surgery has expanded further and now has extra surgical steps involved so it is effective in treating retinal problems as well as vitreous problems.

The vitrectomy surgery is generally completed under a local anaesthetic and involves three incisions being made in the pars plana of the eye (are located between the iris and retina). A light rod, infusion port and vitrectomy cutting device are placed into the inner eye through the incisions made.

The vitrectomy-cutting device has a microscopic cutter that cuts through and removes the vitreous fluid in a slow, controlled manner.

The infusion port is used to replace lost fluids in the eye so no pressure is lost within the eye during and post surgery.

For those with retinal detachment two additional steps are added.

The first step is scleral buckling which places a support belt around the inner wall of the eye so the retina is kept in its correct, attached position within the eye.

The second step is membranectomy, which involves removing unhealthy layers of retina tissue. This is achieved by using the three holes already created for the first part of the vitrectomy procedure but uses different instruments; the instruments used are forceps, picks, and visco-disection.

The visco-section uses jets of fluid to separate layers of tissue which the forceps and picks can grasp and hook before the vitrectomy cutting device can cut away the unhealthy retinal tissu

Some eye patients may not be good candidates for LASIK surgery but do they have an alternative? Yes! You have choices if you are not a candidate for LASIK surgery. They are 30-day contact lenses and they are approved by the Federal Drug Administration to wear for 30 days without removing them for cleaning each day. The FDA recommends that you take them out once a week for cleaning. This will reduce the risk of eye infections.

They are trouble free; you can wear them continuously, wake up and see the alarm clock without fumbling around for your glasses. They are fairly safe, effective, and the cost is reasonable. The contacts are made from a new material called silicone hydrogel. This new material allows more oxygen to flow through the lens and so keeps the cornea healthier.

This 23-hour vision correction alternative could be a good choice for several reasons. LASIK surgery sometimes results in complications after the procedure. These complications include impaired nighttime vision, glares, and halos around bright lights. These complications are being removed by new and improved methods of surgery including new lasers with eye trackers. These eye trackers will adjust if the eye moves and are able to treat larger zones in the eye.

Continuous wear lenses have an advantage in that as you grow older, you may need to have the prescription changed for your lenses. You will have good, sharp vision immediately after you start using them. If you need to, you can switch to bifocal contact lenses, or you can use reading glasses to better see objects closer to you.

Laser surgery has improved, and perhaps the ways of deciding who is a good candidate has also improved so results are better than in the past. The use of custom LASIK enables the surgeon to guide the laser beam because of new mapping technology. LASIK may give an eye patient better than 20/20 vision, but contacts will do that too.

Cost is one item to consider when choosing between extended wear contacts and LASIK surgery. The average cost of 30-day lenses is about $1 a day and reduces the lens care solution you need to buy. These extended wear contacts cost about the same as any other soft contact lens. The cost of LASIK surgery is around $2000 per eye but it does erase the need for vision care products for years. Most surgeons will work out a monthly payment plan so it isn’t always necessary to come pay the full amount up-front. Costs are not eliminated if you have LASIK surgery, you will still need to have yearly eye exams and for eye diseases and infections.

Before making any final decision about extended wear contacts and LASIK surgery, look at the risks and costs. As with any surgery, there is always a risk of infection and some bleeding anytime there is a surgery. The cost may also be a factor. Talk to your doctor about both procedures and see what correction is best for your vision problems.
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Astigmatic keratotomy surgery is safe and effective but has been replaced with the more modern LASIK surgery.  Astigmatism is a problem with many eye patients.  An eye that has astigmatism is shaped like a football.  Surgery is needed to reduce the steepness of the cornea and make it more rounded.  This is often done while other forms of corrective surgery are done.  Astigmatisms are hard to treat unless they are mild.

Astigmatic keratotomy surgery involves one or two incisions allowing the cornea to relax into a more natural state.  This allows the cornea to round out and decrease the steepness to allow for better vision.  Severe forms of astigmatism may be treated with astigmatic keratotomy but may still need glasses or contact lenses for ideal vision.

The advantage of having astigmatic keratotomy eye surgery is that it is a safe and effective way to correct mild astigmatism.  The disadvantages include a slow healing time.  The healing time is normally around three months.  There is a discomfort from this surgery that lasts for two or three days.  Finally, the results are permanent whether they are good or bad.

There are certain side effects of astigmatic keratotomy surgery.  They are rare but you should consider the possibility of side effects occurring.  This can include vision variation especially in the first few months, a weakened cornea that could be easily ruptured, and infection.  Also a common side effect of AK surgery is the difficulty in fitting the eye with contact lenses, light sensitivity, and glares or “halos” around lights at night.  This could be permanent and should be considered before you decide if AK surgery is right for you.

Preparation for astigmatic keratotomy surgery is not difficult.  You will meet with someone who will talk to you about what to expect during and after the surgery, your medical history, and your eyes will be tested.  Your cornea will probably be measured and your eyes diluted so measurements can accurately be taken.  These measurements will be for thickness of the corneal, refraction, and pupil dilation.  You should have questions prepared to ask the surgeon when this has been completed.

If you wear hard contact lenses, you should not wear them for three weeks before surgery.  If you wear soft lenses, you should not wear them for a minimum of three days before you have astigmatic keratotomy surgery.  You will need to be sure to bring your eyeglasses to your surgeon so your prescription can be reviewed and changed if necessary.  When you go to the doctor’s office for surgery, be sure to take any prescription medications you are taking.  Don’t wear eye make-up or heavy jewelry that can cause your head to move during the surgery.  If you are not feeling well on the morning of the surgery, you may want to call the office to let the doctor decide if the eye surgery needs to be postponed.

After surgery, your eyes may be sensitive to light or feel like you have something in it.  Eye drops will be prescribed that will help prevent any infection or inflammation following the surgery.  It will normally take a few weeks before the results of the surgery are known.

he search for a more natural prosthetic eye continues but there has been an important breakthrough in this field.  The purpose of an anophthalmic socket implant is to mimic the movement of the natural eye and give it the look of normalcy.  The best implant would be able to have enough orbital volume to make up for the empty socket, minimal chance for infection and small protrusion or recession in the face.

New progress has been made in this area with a new high-density porous polyethylene with a brand name of Medpor.  This new material resists infection, promotes tissue growth, and nonantigenic.  One other important fact is this new material allows sutures to pass through it.  It has been used successfully as an implant in anophthalmic socket surgery.

New research has been centered on the new porous materials that allow tissue growth, which means the transplant, will last longer and reduce the chance of needing replacement.  The perfect implant would be an implant that reduces infection, has little or no inflammation, and be moldable without extreme rigidity.  Not only would the perfect implant meet all of these requirements it should be easy to make and the costs should be reasonable.  Does that sound impossible?  Research and new technology makes this more probable every day.

Patients who have received implants of this new porous material experienced great benefits and studies continue to see which of the new materials found are most acceptable as an eye implant.

The early study included twenty-one patients who received high-density porous polyethylene implants.  Follow up on these patients continued for nineteen months and results were positive in most patients.  One patient needed the implant removed after four months because of inadequate placement and deformity issues from the trauma to his eye socket.  The removed implant was examined and the surgeons and scientists did not find any infection after being implanted for over four months.  Another implant was performed successfully on this patient.  All other patients reported good results with the porous polyethylene implants.  Patients did not experience any unusual extrusions, infections or other inflammation.

First reports on this new implant material have been positive.  It had a high success rate in its initial clinical trial and mimics as close as possible the other natural eye.  Advantages of this material over others previously used are that it is less expensive to make and looks more natural.  Research is continuing to decide if this implant can be used with an ocular prosthesis to further improve the cosmetic look and movement of the implanted eye.

If you or a loved one faces possible eye removal and are looking for the best implant, they may want to ask their surgeon about this new material.  As research goes on and new improvements are made, this new material is expected to play an important role in all future anophthalmic socket implants.  Scientists believe the era of the “glass eye” is now over.  Patients now have the choice of the most natural looking eye implant available.

Wavefront LASIK surgery is also known as custom LASIK surgery uses 3-dimensional measurements of precisely how your eye processes images.  It then uses those measurements to find out how best to use the laser in reshaping the cornea.  This new customized surgery will correct vision problems that may not be correctable with regular LASIK surgery.  Individualized vision corrections are done precisely with the Wavefront measurements and are extremely precise.  The customized surgery may correct vision problems that glasses and other forms of corrective eye surgery will not correct.

You will need to be qualified under the Food and Drug Association before a surgeon would consider Wavefront LASIK surgery.  There are certain guidelines that need to be met before a surgeon would perform this surgery.  One consideration they will consider is the thickness of your cornea.  If you have high degrees of myopia, hyperopia, and a high astigmatism, you may be a good candidate for this surgery.

There are methods of correcting vision problems such as eyeglasses, or traditional LASIK surgery but other irregularities could not be corrected until the discovery of Wavefront and other technologies connected to customized LASIK surgery.  With custom LASIK surgery a 3-D map is created to measure the way your eyes focus light rays.  It shows the irregularities and the information is used to guide the laser to reshape your cornea and correct the problems.

There are strong benefits to having customized corrective eye surgery.  This new method can improve your eyesight and give you 20/20 vision but will improve how well you see also.  Contrast sensitivity and fine detail is improved and there is a reduced risk of complications.  Post-LASIK problems can include glare, problems with night vision and halos.

There are two kinds of visual aberrations.  This newer technique will treat both higher and lower forms of aberrations.  High-level aberrations can create problems with contrast sensitivity, glare, problems seeing at night, shadows and halos.

Lower forms of aberrations are common refractive errors such as myopia, hyperopia, and mild astigmatism.

What are the advantages to custom LASIK or Wavefront LASIK?  You could possibly have increased visual quality and contrast sensitivity, a greater chance of having 20/20 or better vision, and will have a reduced rate of having night-vision problems such as glare and halos.  You will also have better sensitivity and fine detail vision.  This new surgery may be the answer for people who will not be helped by other forms of corrective surgery.  A professor of ophthalmology from Harvard Medical School states Wavefront LASIK surgery allows the surgeon to improve overall vision quality better than any technique discovered so far.  One statistic states that patients showed 40 percent improvement in their vision after regular LASIK surgery but those patients who had Wavefront LASIK showed an 88 percent improvement in their vision.  This is great news for those patients who were told that corrective surgery would not help correct their eye problems.  Wavefront LASIK may improve eyesight for those patients with a high astigmatism.