OBJEKTIVAN POGLED NA REFRAKTIVNU KIRURGIJU. Damjan Žunić, M.Sc.
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1 OBJEKTIVAN POGLED NA REFRAKTIVNU KIRURGIJU Damjan Žunić, M.Sc.
2 1. Uvod S napredovanjem tehonologije kirurgija postaje sve pristupačniji i učestaliji način korekcije refraktivnih pogrešaka Komplikacije su svedene na minimum Laserska korekcija koristi napredne algoritme u određivanju i korigiranju dioptrije te je postala metoda izbora za korekciju dioptrije za daljinu Clear lens extraction odnosno ugradnja IOL-a se pokazala kao idealna metoda za pacijente koji nisu dobri kandidati za lasersku korekciju vida, ovom metodom možemo korigirati i vid na daljinu i vid na blizinu
3 Laserska korekcija vida se dijeli na 3 metode: 1. LASIK - Laser-Assisted In-Situ Keratomileusis 2. PRK - Photorefractive Keratectomy 3. SMILE - Small Incision Lenticular Extraction Koja je točno uloga navedenih metoda u zahvatu? Priprema rožnice za skidanje dioptrije Navedene metode nemaju veliku ulogu u konačnoj kvaliteti vida nakon zahvata
4 1. PRK Najstarija od navedenih metoda Radi se na površini oka bez flap-a Spor i najčešće bolan oporavak Glavna nuspojava zahvata je suhoća oka Ukoliko dođe do povratka dioptrije moguća je dokorekcija istom metodom Metoda izbora za visoku miopiju sa ili bez astigmatizma Ne preporuča se za korekciju hiperopije
5 1. PRK 2. Laserska korekcija
6 2. LASIK Trenuto zlatni standard Radi se sa flap-om Flap je moguće napraviti mehanički i laserski Brz i bezbolan oporavak Glavna nuspojava zahvata je suhoća oka Ukoliko dođe do povratka dioptrije moguća je dokorekcija istom metodom Metoda izbora za miopiju i hiperopiju sa ili bez astigmatizma
7 2. LASIK
8 3. SMILE Najnoviji pristup od navedenih Radi se bez flap-a Brz i bezbolan oporavak Nema suhoće oka Ukoliko dođe do povratka dioptrije nije moguća dokorekcija istom metodom Moguća korekcija samo miopije sa ili bez astigmatizma
9 1. SMILE
10 O SAMOM ZAHVATU... Sam čin korekcije dioptrije je zaseban dio zahvata i ne ovisi o metodama koje smo spomenuli Zlatnim standardom se smatra WaveFront analiza i korekcija dioptrije Zahvat traje otprilike 30 minuta (oba oka) Koristi se lokalna anestezija Doma se ide odmah nakon zahvata 10 dana nakon zahvata postoje ograničenja Suhoća obično traje 2mj nakon zahvata (LASIK, PRK) Povratak dioptrije se događa u 2% pacijenata Monovision je opcija korekcije vida na blizu
11 TAJNA USPJEŠNOG ZAHVATA Napraviti refrakciju u cikloplegiji Paziti da rezidualna debljina rožnice ne iznosi manje od 300 mikrona ili 2/3 početne debljine Paziti na iznos dioptrije Paziti da zakrivljenost rožnice nakon zahvata ne prelazi 49,00dioptrija (6,89mm) Paziti na promjer zjenice u skotoptičkim uvjetima Paziti na zanimanje klijenta Paziti na godine klijenta
12 KONTRAINDIKACIJE ZA ZAHVAT Bolest oka (npr. keratokonus) Aktivna upala na oku Izrazita suhoća oka Trudnoća Nekontrolirani glaukom Nekontrolirana šećerna bolest
13 3. IOL Ugradnja intraokularne leće je idealno riješenje za pacijente koji nisu motivirani nositi naočale ili kontaktne leće a nisu dobri kandidati za lasersku korekciju vida Zahvat se izvodi isto kao i operacija sive mrene Vrste IOL-a koje se ugrađuju: 1. Monofokalna IOL 2. Monofokalna torična IOL 3. Multifokalna IOL 4. Multifokalna torična IOL
14 3. IOL 1. Monofokalna IOL hiperopija/miopija 2. Monofokalna torična IOL Hiperopija/miopija/astigmatizam 3. Multifokalna IOL Hiperopija/miopija/prezbiopija 4. Multifokalna torična IOL Hiperopija/miopija/prezbiopija/astigmatizam
15 Ugradnja IOL-a 3. IOL
16 3. IOL O SAMOM ZAHVATU... Zahvat traje otprilike 10 minuta (jedno oko) Prilikom zahvata se odstranjuje naša prirodna leća i na njeno mjesto ugrađuje umjetna leća Koristi se lokalna anestezija Nema šivanja, krvarenja, zatvaranja oka... Doma se ide odmah nakon zahvata 10 dana nakon zahvata postoje ograničenja Post operativna suhća oka je rijetka Moguća je Descementopatija u prvih 48-72h Monovision je opcija korekcije vida na blizu sa monofokalnim intraokularnim lećama
17 TAJNA USPJEŠNOG ZAHVATA Napraviti dobar izračun IOL-a (biometrija) Aksijalna duljina oka Keratometrija Dubina prednje očne sobice Vještina kirurga Odabir IOL-a
18 KONTRAINDIKACIJE ZA ZAHVAT Bolest oka (npr. keratokonus) Aktivna upala na oku Trudnoća Nekontrolirani glaukom Nekontrolirana šećerna bolest 3. IOL
19 4. The end Hvala na pažnji Ako imate pitanja stojim vam na raspolaganju
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