1. IN THE NAME OF GOD All-in-one Femtosecond Laser Refractive Surgery Sh.Hanjani, M.D Ophthalmologist

2. All-in–one Femtosecond Laser Refractive Surger y - LK beginning with barraquer in 1950 - Microkeratomes : 1980 – 1990 for ALK and LK - PRK :1988 used & 1995 approved

3. Lasik :Early 1990 ( Burratto & Pallikaris ) Advantages : - Short period of discomfort - Minimal wound – healing reaction - Rapid visual recovery Microkeratom complication : - Button hole flap - Incomplete flap - Irregular flap - Flap displacement Femtosecond laser : ( photo disruption → Gas bubble ) - More accurate flap - ↓ button hole & irregular flap

4. Femtosecond Laser : in other corneal surgeries - PK - LK - EK - Tunnels of intrastromal rings - Remove refractive lenticule within the cornea

5. All-in-one Femtosecond Laser Refractive Surgery 1- Femtosecond lenticule extraction (FLE×) 2- Small-incision lenticule extraction ( SMILE ) Surgical technique - All-in-one FLRS - Myopia ( -10.00 ) - Myopic astigmatism (5) - Hyperopia (+6) underway study. - Patient selection : same criteria as LASIK - Anterior surface of lenticule 80 µ below surface like LASIK and lenticule diameter 5 – 7 mm and minimum lenticule edge 10 – 15 µ - Side cut incision :FLE× : 280 – 330° SMILE : 30 – 50 °(sup or sup.temp)

6. FIGURE 1. A photograph of the VisuMax laser with the patient’s bed.

7. FIGURE 2. Curved contact glass interface of the VisuMax laser.

9. FIGURE 7. A, Initial separation of the posterior surface of the lenticule from the corneal bed in the FLEx procedure. Note that the flap has already been lifted. B, Peeling off the lenticule from the corneal bed in the FLEx procedure. C, The appearance of the cornea after the lenticule has been removed in the FLEx procedure. D, The appearance of the cornea at the end of the FLEx procedure once the flap has been refloated back in place.

11. Complications - Intraoperatively 1- Suction loss Squeezing Fluid ingress Gas bubble 2- Wrong plane selected FLE× SMILE - Post operatively : - Fine scaring of flap & lenticule edge - Dry eye - Fine interface haze - Under and over correction

12. Results - 500 eyes until november 2009 - Results are comparable with excimer laser