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Bringing biology back to refractive surgery

At ELZA, we are bringing biology back to refractive surgery, because every silver lining has a cloud.

At the ELZA Institute in Zurich, when we perform very deep excimer laser ablations, it’s usually for one of two reasons. The first is therapeutic refractive laser surgery, for example using the excimer laser to treat a deep scar instead of performing lamellar corneal surgery. The second is cosmetic: the myopic patient who comes through the door and is at -10 or -11 D. Here, biomechanically, laser-assisted in situ keratomileusis (LASIK) doesn’t make sense (flap creation plus stromal ablation would likely weaken the cornea too much), but photorefractive keratectomy (PRK) might. But nothing is straightforward: the problem – the “cloud” – with such deep ablations is the wound healing response which results in haze formation. We can stop haze formation by applying a small amount of mitomycin C (MMC) with a sponge immediately after ablation. However, the substance is quite toxic (MMC is a chemotherapy drug most often used to treat gastrointestinal, anal, bladder and breast cancers) and it can lead to all sorts of complications. The challenge is to find a way to avoid using it.

We took a biological approach to what has been classically viewed as a physics problem. If the laser ablation is causing inflammation, can we change how the laser energy is delivered to the cornea in order to cause less inflammation? Long story short: we did, and you can read more about it in Concept Ophthalmologie.

 

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