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| '''IntraLASIK''', also known as '''Femto-LASIK''' or '''All-Laser LASIK''', is a form of ] similar to ] that creates a ]l flap with a ] ] ] rather than with a mechanical microkeratome, which uses a steel blade. The only difference between LASIK and IntraLASIK is the method by which the LASIK flap is created. The actual refractive correction by ]l ablation can then be performed with any ] laser that is able to perform LASIK, including conventional, wavefront-optimized, or wavefront-guided ]. IntraLASIK can be used to surgically create ] to enhance the ability to see objects both distant and near for those affected by ].<ref>{{cite web|url=http://www.usaeyes.org/lasik/faq/lasik-monovision.htm |title=Monovision Lasik |publisher=Usaeyes.org |date=2010-04-12 |accessdate=2011-12-10}}</ref> | |||
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| ==History== | |||
| Intelligence Surgical Laser (ISL) approached Arturo S. Chayet M.D. (Mexico) in 1994 with the idea of using a picosecond laser as an alternative to the excimer laser for the correction of refractive errors. Soon enough, however, after a series of clinical trials, Chayet concluded that the picosecond laser was not well suited for refractive corrections, but rather for the creation of corneal flaps, which at the time were created with the mechanical microkeratome (Chayet is credited with the conception of Intralasik). The creation of the corneal flap with the picosecond laser, in conjunction with the use of the excimer laser for the corneal ablation, was the first step to creating a spin-off of LASIK. Researchers at the University of Michigan, however, realized that the picosecond laser was inadequate for Chayet's idea and discovered that the femtosecond laser would work more effectively. In 2000, a corneal flap created by the femtosecond laser along with a refractive error corrected by the excimer laser was conducted on a patient for the first time, in which case Intralasik or All Laser LASIK was conducted for the first time. | |||
| The term IntraLASIK is derived from ], the name of the first manufacturer to achieve Food and Drug Administration approval of a femtosecond laser for use in the United States,<ref>{{cite web | |||
| | url = http://www.fda.gov/ohrms/dockets/ac/00/transcripts/3658t1_a.pdf | format = PDF | |||
| | title = Ophthalmic Devices Panel | |||
| | date = 2000-11-08 | |||
| | publisher = ] | |||
| }}</ref> and the surgical procedure 'LASIK'. Although additional femtosecond laser manufacturers have entered the US market,<ref>{{cite web | |||
| | url = http://www.fda.gov/cdrh/pdf5/K053511.pdf | |||
| | title = 510(k) Summary for the Femtosecond Laser Microkeratome | |||
| | publisher = ] | |||
| | date = 2006-03-11 | |||
| }}</ref> the name ''IntraLASIK'' is commonly used. | |||
| ==Procedure== | |||
| The computer-guided infrared femtosecond laser is focused just below the surface of the cornea. Each laser pulse creates a tiny bubble there. A pattern of many overlapping bubbles is created, allowing to lift off a flap off the cornea. The procedure then continues as in traditional LASIK, with an excimer laser removing material from the exposed surface beneath the flap. | |||
| ==Claimed advantages== | |||
| A LASIK flap created with a femtosecond laser is regarded by many ]s{{Who|date=July 2007}} as an improvement over traditional LASIK because of a greater accuracy in flap size, shape, and thickness. | |||
| Contradictory information exists as to whether the use of femtosecond lasers in LASIK achieves statistically better ] and ] outcomes than with microkeratomes.<ref>{{cite journal |author=Durrie DS, Kezirian GM |title=Femtosecond laser versus mechanical keratome flaps in wavefront-guided laser in situ keratomileusis: prospective contralateral eye study |journal=J Cataract Refract Surg |volume=31 |issue=1 |pages=120–6 |year=2005 |month=January |pmid=15721704 |doi=10.1016/j.jcrs.2004.09.046 |url=http://linkinghub.elsevier.com/retrieve/pii/S0886-3350(04)01045-4}}</ref><ref>{{cite journal |author=Lim T, Yang S, Kim M, Tchah H |title=Comparison of the IntraLase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis |journal=Am. J. Ophthalmol. |volume=141 |issue=5 |pages=833–9 |year=2006 |month=May |pmid=16678504 |doi=10.1016/j.ajo.2005.12.032 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9394(05)01352-8}}</ref> | |||
| Although the final long-term clinical outcome of LASIK with a mechanical microkeratome and IntraLASIK with a femtosecond laser may be similar, the increased accuracy of the flap with the femtosecond laser provides an added margin of safety. LASIK with a flap that is thinner has been shown to provide outcomes superior than a thicker LASIK flap.<ref>{{cite journal |author=He TG, Shi XR |title= |language=Chinese |journal=Zhonghua Yan Ke Za Zhi |volume=42 |issue=6 |pages=517–21 |year=2006 |month=June |pmid=16857131 }}</ref> A thinner LASIK flap requires greater accuracy and predictability. | |||
| ==Complications== | |||
| A small percentage of IntraLASIK patients develop Transient Light Sensitivity (TLS)<ref>{{cite journal |author=Stonecipher KG, Dishler JG, Ignacio TS, Binder PS |title=Transient light sensitivity after femtosecond laser flap creation: clinical findings and management |journal=J Cataract Refract Surg |volume=32 |issue=1 |pages=91–4 |year=2006 |month=January |pmid=16516785 |doi=10.1016/j.jcrs.2005.11.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0886-3350(05)00912-0}}</ref> which causes severe ] for a period of weeks, however normally resolves with healing and treatment. | |||
| ==Alternatives== | |||
| An alternative to IntraLasik, ], is a ] ] technology that is one of several possible alternatives to ] now under investigation. Lower-energy femtosecond lasers may improve upon the traditional excimer laser by reducing disruption of ocular structures, with intrastromal ablation obviating the need for the damaging ] incision and ablation currently employed in LASIK and ] procedures. | |||
| First clinical results were obtained in 2003,<ref name=fclin>{{cite journal |author=Ratkay-Traub I, Ferincz IE, Juhasz T, Kurtz RM, Krueger RR |title=First clinical results with the femtosecond neodynium-glass laser in refractive surgery |journal=J Refract Surg |volume=19 |issue=2 |pages=94–103 |year=2003 |pmid=12701713 }}</ref> and several different techniques are now under investigation, including both ] (intrastromal PRK), and more ambitious wavefront variants. It is believed that intrastromal techniques may eventually increase predictability and repeatability of wavefront ablation. Both ] and ] are known to be sponsoring FLIVC studies using their respective lasers. | |||
| ==See also== | |||
| ==References== | |||
| {{reflist}} | |||
| ] | |||
| ] | |||
| ] | |||
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