Refractive surgery

Refractive surgery includes all techniques used to correct refractive defects: myopia, astigmatism, hypermetropia, anisometropia, presbyopia.

The aim of refractive surgery is to improve natural visual acuity, to eliminate or reduce the use of glasses or contact lenses, to improve the quality of life of the patient (Professional Ethics).

Refractive surgery began to take its first steps at the end of the 1980s, with techniques which have since evolved. As this science now has a twenty-year history, we have been able to follow over time how the eye reacts to surgery and to assess the ongoing effectiveness of the various techniques.

Nowadays we are able to meet the needs of most patients as a result of the wide range of techniques available, the precision of the equipment used and our great surgical experience. However not all patients are suitable for such surgery. The preliminary tests and the specific diagnostic tests are required to assess the suitability of a patient and to define the best surgical technique for each one.

Who is Refractive Surgery intended for

All patients who have a refractive defect such as MYOPIA, ASTIGMATISM, HYPERMETROPIA, ANISOMETROPIA, PRESBYOPIA.
For a patient to be considered suitable for such an operation, their visual defect must be stable, they must have no glaucoma, no ocular inflammation, any diseases of the cornea or in particular keratoconus, they must have no general illnesses (diabetes, collagenopathy, neuropathy).
In some selected cases, particularly in the case of anisometropy (there is a refractive difference between the two eyes), early intervention could be required in order to improve the accommodation between the two eyes, and the binocular function.
Recommendation for surgery in any case depends not only on the extent of the visual defect noted by the eye specialist, but more importantly on the personal and professional reasons expressed by the patient (Professional Ethics).

Techniques

The eye specialist chooses the best surgical technique according to the extent of the refractive defect, the data which emerged from the diagnostic tests and the age of the patient.
The techniques which may be used are:

Excimer laser

Excimer laser

Femtolaser

Femtolaser

Microsurgery

Microsurgery

Pre and Post Operation

Pre-Operation

1. Preparation

Patients who wear contact lenses and who plan to undergo surgery must stop using the lenses a few days before the pre-operative tests and before the operation itself

HARD AND GAS PERMEABLE LENSES: 15 days before
SOFT LENSES: 3-4 days before
DISPOSABLE LENSES: 1 day before

This is necessary because contact lenses modify the shape of the cornea.
To surgically obtain the best and most stable eyeball shape in the long term, it is essential that when the diagnostic data emerges and when the operation takes place, the eye has already recovered its authentic shape and has lost the distorted shape caused by contact lenses.
This return to a normal shape occurs in the period when the lenses are no longer used.

2. Clinical and instrumental examinations

The patient undergoes the following tests to assess suitability for an operation and to plan the ideal surgical strategy.

  • Biomicroscopy
  • Corneal Topography
  • Aberrometry
  • Pachymetry
  • Biometry
  • Endothelial Microscopy
  • Tonometry
  • Refraction Test
  • Cycloplegia
  • Fundus Examination
  • Pupillometry
  • Ocular Motility

3. The day of the operation

The patient must:

  • Not wear make-up or perfums
  • Not take any kind of sedatives
  • Take any drugs which they take daily (blood pressure drugs,...)
  • Arrive with someone as they will not be able to drive in the first few hours after surgery

Post-Operation

Post-operative recovery can be very different depending on the technique used.

OPERATIONS WITH SURFACE EXCIMER LASER (PRK; LASEK; EPILASIK)

  • In the 48-72 hours after the operation, patients may feel discomfort such as burning, foreign body sensation, pain.
  • The eye is open during this period, protected by a therapeutic contact lens and medicated with antibiotic eye drops, anti-inflammatory drugs and lubricating eye drops.
  • Patients are advised to take systemic analgesics.
  • In this phase, corneal re-epithelisation is completed.
  • After completing the re-epithelisation, the therapeutic lens is removed and the irritation disappears.
  • Lubricating eye drops continue to be used for a number of months.
  • The return of visual capacity is gradual and fully back to normal within a period of a few weeks.
  • Refractive stabilisation occurs within a few months.
  • CLINICAL CHECK-UPS:
    • Day 1
    • Day 3
    • Day 7
    • Weekly for 1 month
    • Monthly for 6 months

INTRASTROMAL OPERATIONS (LASIK, FEMTOSECOND LASER)

  • Irritation (burning, foreign body sensation) is limited to one or two hours after the operation.
  • The eye is protected by a transparent plastic shell for the first day, with no contact lens.
  • Post-operative treatment involves the use of antibiotic eye drops, anti-inflammatory drugs and lubricating eye drops, with no need to take systemic analgesics.
  • Post-operative recovery is usually asymptomatic and painless.
  • Vision returns within 12-24 hours.
  • Refractive stability returns within a few weeks
  • CLINICAL CHECK-UPS:
    • Day 1
    • Day 3
    • Day 7
    • Weekly for 1 month
    • Monthly for 6 months

MICROSURGERY (PHAKIC LENSES, REFRACTIVE LENSECTOMY)

  • Post-operative recovery is usually painless.
  • Treatment requires the use of antibiotic or cortisone eye drops and anti-inflammatory drugs for a few weeks.
  • Visual acuity returns within one or two days.
  • Refractive stability is immediate.
  • CLINICAL CHECK-UPS:
    • Day 1
    • Day 3
    • Day 7
    • Weekly for 1 month
    • Monthly for 6 months
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