Refractive surgery by corneal photo ablation is a functional elective surgery for correcting refractive defects of the eye such as myopia, hyperopia, astigmatism and presbyopia.
These refractive defects have a common factor concerning focus of the image away from the retina (either forwards or backwards), with corollary blurred vision without optical correction.
It aims to make patients independent of optical correction by glasses or contact lenses.
It functions via a reshaping of the cornea with an excimer laser in order to change the anterior radius of curvature of the cornea (ie the optical power) and thus correct the refractive disorder.
There are two surgical techniques :
- LASIK, also called laser in situ, where the laser is applied through the thickness of the cornea after making a superficial corneal “flap” which replaced at the end of the operation. Cutting the flap can be performed via a microkeratome or a femtosecond type of laser which is more precise and predictable. Postoperatively, the eyes are painless, visual recovery is rapid the following day. This technique is considered gold standard, it is performed when the cornea is strictly normal before surgery..
- PKR (photorefractive keratectomy), also called surface laser, where the laser is used on the surface of the cornea, after removal of the corneal surface known as the epithelium. Postoperatively, the eyes are more painful for three to four days and visual recovery is more progressive (from a few days to a few weeks). This technique is performed when the patient’s cornea does not allow operation with the LASIK technique (thin, irregular or asymmetrical cornea).
Results and visual recovery time are identical (between one and two months), whatever the technique chosen.
In practice, the procedure is usually bilateral, lasts up to 30 minutes per patient, and is practiced as an outpatient under local anesthesia by eye drops.
Corrections (rare <10%) are possible within six months.
Refractive Surgery at Poitiers University Hospital of
Poitiers University Hospital is the first health centre in the Vienne department to be equipped with the new femtosecond laser technology, specializing in Lasik techniques for myopia surgery, presbyopia surgery, hyperopia surgery and astigmatism surgery.
Today, this well known surgery is performed with a laser. It is fast, often painless, and the visual recovery is dramatic within a few hours. It employs the techniques of femtosecond and Excimer lasers.
PKR techniques (photo refractive keratectomy) and LASIK (laser in situ keratomileusis) are now extremely efficient.
The Lasik technique practiced by our surgeons is “100% laser Lasik”, also called “Femto-Lasik.”
The solutions are adapted for each patient in refractive surgery depending on the specific assessment conducted at the University Hospital of Poitiers.
Each case must first be evaluated by taking specific measures (objective and subjective refraction, pachymetry, keratometry, corneal topography, pupillometry, aberrometry, axial biometrics, Optical Coherence Tomography…). However some patients may have contraindications.
*1: Bilan anatomique par la topographie d’élévation ORBSCAN® montrant une asymétrie verticale de cambrure avec l’hémi-cornée inférieure plus cambrée. Le patient présente ici le diagnostic de kératocône frustre. Le diagnostic du kératocône fruste est une priorité en chirurgie réfractive, car le LASIK y est contre-indiqué, sous peine de risquer la survenue d’une ectasie cornéenne.
The type of surgical solution chosen depends on the nature of the vision disorder to be treated, but it can also vary according to the patient’s age. Thus modern refractive surgery may call for different Femtosecond and excimer lasers but also, if necessary, refractive lens surgery with diffractive multifocal toric implants.
These operations are not reimbursed by social security, as they are considered as elective surgery, but today more and more private health insurance policies cover part of the cost of surgery.