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Complications and Management in Laser Refractive Surface Ablation (SA)

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Complications in Corneal Laser Surgery

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Abstract

This chapter gives an overview on one of the oldest, but still indispensable corneal refractive laser surgery strategy. Whereas the currently most often performed corneal refractive strategies involve the creation of corneal lamellae either on the surface (LASIK) or within the corneal stroma (SMILE®), surface ablation (SA) aims to reshape the corneal curvature by directly ablating the corneal surface. SA was the first corneal refractive treatment performed with an Excimer-laser-system and thereby completely changed the world of refractive surgery. The oldest realized SA was the photorefractive keratectomy (PRK). It pioneered the field of laser-refractive-surgery more then 30 years ago and has been approved by the United States Food and Drug Administration (US FDA) in 1995 [1, 2]. The common principle of SA strategies is to remove the corneal epithelium either solely mechanically, with the aid of alcohol or with the Excimerlaser itself (see Table 11.1). After performing the abrasio, the laser ablates the corneal tissue using an ultraviolet 193 nm wavelength beam with a mixture of argon-fluorine gas serving as the energy source. Modern Excimer-laser systems work with pulse frequencies of 200–500 Hz. The corneal tissue absorbs the emitted laser-energy, so the effect concentrates on the surface without altering the deeper layer of the cornea. The binding energy of the corneal molecules is 3.6 − 6.4 eV. During the photoablation, the laser bursts these inter-molecule-connections [3–5]. The released kinetic energy of the free protons results in a smoke emission observable during the treatment. Thus, almost no photodisruptive or thermic damage to the surrounding corneal tissue occurs [6].

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Authors and Affiliations

  1. zentrumsehstärke, Martinistr. 64, Hamburg, 20251, Germany

    Johannes Steinberg MD

  2. Department of Ophthalmology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Stephan J. Linke MD, PhD

  3. CareVision Germany, Martinistr. 52, 20246, Hamburg, Germany

    Stephan J. Linke MD, PhD

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  1. Johannes Steinberg MD
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Correspondence to Johannes Steinberg MD .

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  1. Department of Ophthalmology, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany

    Stephan J. Linke

  2. Department of Ophthalmology, University Medical Center Hamburg Eppendorf, Hamburg, Germany

    Toam Katz

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Steinberg, J., Linke, S.J. (2016). Complications and Management in Laser Refractive Surface Ablation (SA). In: Linke, S., Katz, T. (eds) Complications in Corneal Laser Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-41496-6_11

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