激光在眼科（60）课件

ADVANCES IN LASER & EYE SURYA Dr. Ajay Dudani Dr. Vinod Goyel SURYA EYETECH Mulund, Mumbai ISO 9001 : 2000 Certified SURYA ZEN EYE CENTRE Khar, Mumbai What is LASER ? L - Light A - Amplification by S - Stimulated E - Emission of R - Radiation SURYA What is LASER ? Substances have the property to “lase” i.e.absorb energy in one form & emit a new form of light energy which is more useful. SURYA Types of Lasers SURYA Tissue Interactions SURYA Modes of Operation Mode depends on Laser material & Mode of excitation of material Two modes- Continuous wave operation Conventional pulsed operation - Q switched - mode locked SURYA Delivery Systems Transpupillary- Slit lamp - Laser Indirect Ophthalmoscopy Trans scleral- Contact - Non contact Endophotocoagulation SURYA SURYA Radiation Wavelengths 193 nm - Excimer (Cornea) 488 - 514 nm- Argon (Retina) 694.3 nm- Ruby 780 - 840 nm - Diode 1064 nm- Nd Yag (Capsule) 10,600 nm- Carbon dioxide (Skin) SURYA Uses Diagnostic Therapeutic SURYA Diagnostic Uses Laser Fluorescence Spectroscopy Scanning Laser Ophthalmoscopy Laser Interferometry Fundus Fluorescein Angiography Ffa PIC SURYA Therapeutic Uses Widely Used - Extra-ocular adnexae Anterior Segment Posterior Segment SURYA i. Removal of lid masses ii. Orbitotomies iii. Blepharoplasty, Aesthetics (smoothen wrinkles) iv. Capillary hemangioma, Portwine stain Therapeutic Uses A. Extraocular Adnexae SURYA B. Anterior Segment i. LASIK, PRK, PTK Therapeutic Uses SURYA What is LASIK ? Therapeutic Uses SURYA Suitable for 2 to 9 Dioptres of Ref. Error OPD Procedure 5 minutes per eye LASIK Therapeutic Uses SURYA Suction RingMicrokeratomeFlap Removed LASIK Therapeutic Uses SURYA LASIKFlap ReplacedPost - Op. B. Anterior Segment Therapeutic Uses ii. Conjunctival / Corneal Growths, Neovascularization iii. Cyclophotocoagulation SURYA Therapeutic Uses B. Anterior Segment SURYA What is Glaucoma ? Therapeutic Uses SURYA iv. Reopen failed filtering blebs v. Iridoplasty, Gonioplasty vi. Iris cyst, Pupilloplasty Therapeutic Uses B. Anterior Segment SURYA vii. Posterior Capsular Opacification Therapeutic Uses B. Anterior Segment SURYA Therapeutic Uses C. Posterior Segment SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA What is Diabetic Retinopathy ? Therapeutic Uses SURYA Severity of DR runs parallel to the duration of DM 50 % of Diabetics have DR after 10 years of DM 90 % of Diabetics have DR after 20 years of DM A regular checkup every 6 - 12 months can detect early changes & prevent blindness i. Diabetic Retinopathy Therapeutic Uses SURYA i. Diabetic Retinopathy Therapeutic Uses Focal Grid Panretinal SURYA ii. Retinal Haemorrhage Therapeutic Uses SURYA iii. Retinal Breaks or Tears Therapeutic Uses SURYA iv. Subretinal neovascularisation v. Central serous retinopathy Therapeutic Uses C. Posterior Segment SURYA vi. Vitreolysis in cystoid macular edema Therapeutic Uses C. Posterior Segment SURYA vii.Vitreous traction bands, to free encapsulated foreign bodies Therapeutic Uses C. Posterior Segment SURYA viii. Drainage of subretinal fluid / haem. Therapeutic Uses C. Posterior Segment SURYA ix.Intraocular tumors (RB) Therapeutic Uses C. Posterior Segment SURYA ix.Intraocular tumors (Choroidal Melanoma) Therapeutic Uses C. Posterior Segment SURYA x.Laser scleral buckling Therapeutic Uses C. Posterior Segment SURYA i.Neovascular stimulation ii.Aseptic phototherapy for pre-op preparation iii.Laser asepsis for diagnosed infectious corneal ulcers iv.Endonasal DCR Therapeutic Uses D. Miscellaneous Uses SURYA What is the Latest ? PDT (Photo Dynamic Therapy) TTT (Transpupillary Thermo Therapy) SURYA What is ARMD ? SURYA Two types - Dry ARMD Wet ARMD What is ARMD ? SURYA Wet ARMD - Rare More devastating Drusen SRNVM What is ARMD ? SURYA Drusen What is ARMD ? SURYA SRNVM What is ARMD ? SURYA Vision in ARMD What is PDT ? Visudyne (Verteporfin) “Smart Bomb” for wet ARMD Selective Damage of SRNVM Costly SURYA What is PDT ? SURYA What is PDT ? SURYA What is PDT ? SURYA What is PDT ? SURYA What is PDT ? SURYA Zeiss Visulas 690s and Visulink PDT adapter Coherent Opal Photoactivator and LaserLink adapter What is PDT ? SURYA What is PDT ? SURYA Treatment is designed to reduce the risk of vision loss Vision improves in few cases Re-treatment is often required at 3-month intervals during the first 2 years What is TTT ? For wet ARMD “Slow Cooking” of CNVM Cheap SURYA Lasers can. Save a