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INTRALASE
Intralase
Intralase is a femtosecond laser that allows the performance of
precise cuts in the cornea, eliminating the need for the scalpel,
drills or knives in corneal surgery. Its main indications are in
refractive surgery to correct myopia, hyperopia and astigmatism,
in patients requiring intrastromal or Ferrara rings to correct keratoconus,
and in patients requiring corneal transplant.
Refractive surgery
The technique most often used to correct refractive errors (myopia,
hyperopia, and astigmatism) is LASIK. With this technique, a flap
is made in the cornea, which is lifted to apply the excimer laser
and correct the refractive error with an ablation or evaporation
of the corneal surface. Before this procedure, this flap was
created using a microkeratoconus, which employed a knife to
make an incision 120 to 180 microns deep, with a diameter of 8.5
to 9.5 mm. Intralase makes this flap using femtosecond laser,
performing the LASIK with 100% laser for the first time. Intralase
allows the surgeon to make a flap of different diameters and depths,
depending on the corneal characteristics of each patient, reducing
the risk of knife-related complications, such as irregular, incomplete
or free (total) flaps.
Intrastromal or Ferrara
Rings
In tropical countries, such as Costa Rica, there is a high incidence
of keratoconus, which is a deformation of the cornea or natural
outer lens of the eye, due to its thinning and consequent weakening;
it becomes deformed and causes irregular myopia and astigmatism.
This deformation causes poor visual quality that is not adequately
corrected with glasses, requiring hard or semi-hard contact lenses.
Many patients do not tolerate these lenses, or else their keratoconus
(especially in young patients) keeps advancing, making their eyesight
increasingly worse. In these cases, intrastromal or Ferrara rings
can be placed in the peripheral cornea. They have a flattening effect
on the central cornea, providing it with a more adequate curvature,
and improving not just the patient’s graduation, but also
their vision. Both Dr. Orlich and Dr. Rechnitzer were pioneers in
Central America in the use of these rings, being trained by directly
by Dr. Ferrara in Brazil, and placing the first implants in 2005.
Hundreds of patients have undergone surgery in Costa Rica for intrastromal
rings. Before Intralase, these needed to be placed with a manual
technique, requiring great accuracy by the surgeon. Currently, the
rings are placed inside the cornea with incomparable precision,
as the Intralase makes the space where the rings will be placed,
at the exact depth required and perfectly centered, improving results
and reducing the main complication of this procedure, which was
extrusion or exposure of the rings on the corneal surface.
Corneal transplants
One of the more fascinating indications of Intralase is performing
the corneal cut of both the donor and the recipient in corneal transplants.
Since 2006, some of the best ophthalmological hospitals in the world
perform their corneal transplants with Intralase, ours being the
first and, so far, the only one in Central America and the Caribbean.
One of the main problems after manual transplants performed with
drills (round knife) and scissors is that edges are not always neat,
as irregularities and imperfections in the corneal cut remain. This
leads to more dependency on glasses or contact lenses after the
surgery. With Intralase, the cut is perfect, both for the donated
cornea and for the recipient or patient. Moreover, it is not only
perfect, but the Intralase allows us to make different cut patterns,
which improves the contact surface between the donated cornea and
the recipient or patient cornea, in turn improving healing, and
preventing fluid or aqueous humor leakage and other complications
that can present with the manual technique. One of the advantages
of Intralase is that it allows for earlier removal of sutures, promoting
faster recovery, reducing post-operatory astigmatism and thus better
vision after the transplant.
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2010.