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

Ella Faktorovich MD

 
 
 

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$139.95

ISBN 13 978-1-55642-862-3

264 pp Hard Cover

Pub. Date: 2009

Order# 68623

 

 

 

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Product Description

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

  • Strategies for centration
  • Decreasing the incidence of opaque bubble layer formation
  • Optimizing the energy delivered to the cornea
  • 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 Lasers is a useful guide for beginning surgeons as well as surgeons looking to develop or enhance their working knowledge of femtosecond lasers.

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Contents

Dedication
Acknowledgments
About the Author
Foreword by Barry S. Seibel, MD
Preface

Chapter 1: History and Applications of Femtosecond Lasers

  Principles of Laser-Matter Interaction
  Femtosecond Lasers
    Applications of Femtosecond Lasers

Chapter 2: 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

Chapter 3. 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

Chapter 4. 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

Chapter 5. 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
(Contributed by Barry S. Seibel, MD)
    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

Chapter 6. LASIK With AMO Femtosecond Lasers: Getting Started

  Overview
  Mastering Applanation
  Mastering Flap Lift
  Optimizing Energy Settings: Where to Begin?
  Postoperative Findings
  Summary

Chapter 7. LASIK With AMO Femtosecond Lasers: Troubleshooting

  Problem 1: OBL
    Causes
    Solution
    Pocket OBL
    Pocket/Bed OBL
    Bed OBL
    Pocket OBL
    Pocket/Bed OBL
    Bed OBL
  Problem 2: OBL in the Area of Ablation, Tracking, or Iris Registration
    Causes
    Solution
  Problem 3: Difficult Flap Lift/Flap Lift in the Area With OBL
    Causes
    Solution
  Problem 4: Flap Stretch
    Causes
    Solution
  Problem 5: Flap Striae
    Causes
    Solution
  Problem 6: Flap Tear
    Causes
    Solution
  Problem 7: Peripheral Tags
    Causes
    Solution
  Problem 8: OBL, Difficult Flap Lifts, and Peripheral Tags Despite
    Optimized Laser Settings and Techniques
    Causes
    Solution
  Problem 9: Loss of Suction
    Causes
    Solution
  Problem 10: Vertical Gas Breakthrough
    Causes
    Solution
  Problem 11: Horizontal Gas Breakthrough
    Causes
    Solution
  Problem 12: Bubbles in the Anterior Chamber
    Causes
    Solution
  Problem 13: Difficulty Tracking and Iris Registration During
    Excimer Laser Ablation
          Causes
          Solution
  Problem 14: Subconjunctival Hemorrhage
    Causes
    Solution
  Problem 15: Decreased Visual Acuity at Postoperative Day One
    Causes
    Solution
  Problem 16: Peripheral Lamellar Keratitis
    Causes
    Solution
  Problem 17: Transient Light Sensitivity Syndrome
    Causes
    Solution

Chapter 8. LASIK With Emerging Femtosecond Laser Systems

  Ziemer Femto LDV
    Technical Features of Ziemer Femto LDV Laser System
    System Settings for LASIK Flap Creation
    Procedure Techniques for LASIK Flap Creation
    Trouble Shooting
  VisuMax
    Technical Features of VisuMax Laser System
    Overview of LASIK Flap Creation
  Femtec
    Technical Features of the Femtec Laser System
    Overview of LASIK Flap Creation

Chapter 9. Intracorneal Ring Segments

  Overview
  Laser Settings
  Procedure Techniques

Chapter 10. IntraLase-Enabled Laser Keratoplasty
                (Contributed by Roger F. Steinert, MD)

  Overview
  Development
  Penetrating Keratoplasty
    The Zig-Zag Incision Pattern
    Surgical Technique
  Lamellar Keratoplasty
    Overview
    Surgical Technique
  Future Directions

Chapter 11. Future of Femtosecond Laser Technology

  Femtosecond Lenticular Extraction
  Femtosecond Laser Astigmatism Correction (FLAC)
  Femtosecond Laser Intrastromal Correction of Presbyopia (intraCOR)
  Femtosecond Lens Surgery (FLeS)
  Femtosecond-Assisted Corneal Biopsy (FAB)
  Femtosecond-Assisted Limbal Stem Cell Harvesting
  Femtosecond Glaucoma Surgery
  Femtosecond-Assisted High Resolution Tissue Imaging

Glossary

Index

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About the Author

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.

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