With the numerous significant advances in surgical methodology--e.g., microinstrumentation, the operating microscope, the surgical keratometer, and intraocular lenses--that have been developed over the past two decades, both surgeons and patients have become increasingly aware of the final optic result of any surgical intervention. This is especially so since the development of refractive surgery, where good uncorrected vision is frequently the final arbiter of success. We have progressed to the stage where the optic manipulation of the cornea, whether intentional or otherwise, can be understood in terms of a number of variables. These include the preparation and closure of the surgical wound, the choice of suture material, and both intraoperative and postoperative manipulations. Where these have failed and postoperative astigmatism still occurs, a number of surgical procedures are available to reduce the astigmatic error to an acceptable level.
Stretching and compressing of laser pulses is demonstrated with a single-grating apparatus. A laser pulse of 110 fs is stretched to 250 ps and then recompressed to 115 fs. The apparatus exploits a two-level structure: one level for stretching and the other for compressing. This single-grating configuration shows significant simplification in structure and alignment over existing multiple-grating systems. Such a stretcher-compressor is particularly suitable for use with chirped-pulse amplification in which laser wavelength tuning is desirable. Only one rotational adjustment is rquired to restore the alignment of the entire stretcher and compressor when the laser wavelength is changed.
After lamellar refractive surgery, the topography of the cornea is significantly altered. Although the postoperative keratometry readings are steeper than the actual curvature, they are reasonably reliable for determining the base curve of the initial trial lens, validating the use of conventional methods of fitting rigid contact lenses in patients who have had MKM.
Satisfactory clinical results have been obtained with lamellar refractive keratoplasty (keratophakia, keratomileusis, and epikeratophakia). However, the techniques are accompanied by several disadvantages, most notably technical difficulty, inaccuracy, delayed visual rehabilitation, and excessive tissue destruction due to freezing or lyophilization. The author herein describes a new technique that is capable of producing lamellar refractive lenticules without the use of freezing or lyophilization, thereby maintaining cellular viability. The technique has a different theoretical and mechanical basis than cryorefractive surgery as presently performed. Laboratory investigation demonstrates that high refractive errors, both myopic and hyperopic, may be correctable by this method, while preserving the normal corneal architecture.
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