Fixing complications after laser eye surgery

At the ELZA Institute, we can correct complications from previous LASIK, SMILE and PRK surgery so that patients can achieve a better quality of vision

What is it?

Definition

The ELZA Institute has a global reputation for fixing laser surgery complications. Prof.Hafezi, the Medical Director of the ELZA Institute, has 25 years of experience in laser refractive surgery, and this experience is a key reason why patients are referred from all over the world to ELZA to have failed refractive surgeries repaired by us.

Below are some examples of ELZA fixing complications after laser surgery:

Repairing PRK: fixing a decentered ablation

Repairing a decentred ablation.

The “before” image on the left is from an old PRK for myopia from the early 2000s, but unfortunately, the laser ablation was de-centered, and this has left the center of the cornea “multifocal” – meaning that the patient has blurred vision, especially at night, when the pupil is large.

The “after” image is after correction at ELZA with a wavefront-guided transPRK. We have been able to give the patient a big, homogenous optical zone, and this gives the patient a distinct improvement in visual quality and visual acuity, in both light and dark conditions.

After

Before

Repairing LASIK: improving poor vision at night

Thanks to limitations of early excimer lasers, refractive surgeries performed in the early 2000s (like the case presented below) had small optical zones – in other words, the region in the centre of the cornea that was corrected was relatively small. This meant that during daytime, when there is lots of light, the patient’s pupil is small, and the patient sees well. But at night, when the pupil is large, the light starts to come through the uncorrected parts of the cornea, which is “multifocal”, and the patient’s vision gets considerably worse.

At the ELZA Institute, we were able to correct this LASIK complication using a wavefront-guided transPRK to expand the optical zone size to a much larger one, meaning that the patient could see well in both light and dark conditions.

After

Before

Fixing SMILE surgery complications: patients with large pupils

Tiny optical zones aren’t limited to old laser surgeries; here is a case of a young patient (in their early thirties) with a small optical zone after small incision lenticule extraction (SMILE) surgery, who had good vision during daylight (when the pupil is small), but had significant issues with their vision in darker conditions (when the pupil was large). We performed a wavefront-guided PRK to enlarge the optical zone.

The main feature of SMILE surgery is that the laser performs the vision correction by cutting a “lenticule” within the cornea and a tunnel to the surface that the surgeon uses to remove the tissue. However, the surgeon needs to use a tiny spatula to dissect the lenticule from the stroma, as the laser is not able to separate one from the other completely. This is a potential point of failure: if the lenticule is not completely detached, and some tissue is left behind, then the patient will have significant visual issues afterward. This was the case with the patient presented below. We rehabilitated the patient’s vision by performing a wavefront-guided surface treatment over the optical zone in the center, recovering much of what the patient lost with the failed SMILE surgery. The patient is at 100% of visual acuity without glasses, both during daytime and at night.

After

Before

After

Before

What can I expect?

You cannot expect being completely free of glasses or reaching perfect vision. Fixing a failed refractive laser surgery is much more demanding than performing the original surgery. In many cases, we can improve on the situation, but sometimes even we cannot normalize vision completely. Our aim is to get you to the best visual quality possible. In some cases, you will still need glasses after our reconstructive surgery, but the vision you can achieve with glasses will be much better than anything you achieved prior to our repair..

Categories: Farhad Hafezi | Popular press

Repairing failed SMILE procedures in the strongest way possible

The success of SMILE procedures depends not only on the expertise of the surgeon but also on the ability to correct any complications that may arise. Prof. Hafezi’s article provides insight into the various approaches available for repairing failed SMILE procedures. Corneal wavefront-guided transPRK stands out as a method that offers significant advantages, including improving the corneal biomechanics and avoiding postoperative ectasia.

READ

Bringing biology back to refractive surgery

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?

READ

Categories: Farhad Hafezi | Sabine Kling | Scientific article

Fixing your SMILE: how do you reoperate, and what are the consequences for corneal strength?

Other vision healthcare professionals regularly refer patients to ELZA who have “challenging corneas”; many are those whose original laser refractive surgery didn’t quite go to plan, and they need re-treatment to fix their vision