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OCULAR LASER THERAPY الليزر وتطبيقاته في مجال طب العين اعداد  :  الدكتور  محمد منير الشنواني  -  الرقه
الله نور السماوات والارض Lasers are a kind of light  that is different than light from the sun,
There are also kinds of energy which are invisible to people's eyes Light is energy  people can see infrared  -  this energy can't be seen but is able to be felt  as  heat radio   -  people can't see this energy , b ut radio's can turn it into  s oun d microwave  -  this energy can be used to  cook food But there are photons which have a  wavelength  that is just right for the human eye to see. النانومتر هو جزء من مليار جزء من  المتر one millionth of a millimetre 1 nanometre   = فمتومتر   |  أنغستروم   |  نانومتر  |  ميكرومتر   |  مليمتر   |  سينتمتر   |  ديسيمتر   |  متر   |  ديكامتر   |  هيكتومتر   | كيلومتر
عندما يجري تحفيز جهاز الليزر ترتفع طاقة ذراتها من المستوى الادنى إلى المستوى الاعلى ،وتعاود الانخفاض إلى مستوى الطاقة الادنى مرورا بالمستوى الأوسط نتيجة عدم استقرار الجسيمات الواقعة في مسار الطاقة ، عندها تنبعث  ا لفوتونات  التي تعطي رنينا في جهاز الليزر  وتخرج من الجهاز  بطاقة كبيرة   وصلت اقصى ما وصلت اليه  1700  مليون ميجاواط  و يتم التفاعل  في  ثلاثة على عشرة ملايين ثانية  وضغطها   مليون وخمسين الف كيلو جرام على السنتيمتر  ا لمربع  ودرجة الحرارة  بين  100-200   الف درجة ). BOHR ATOM´S MODEL nucleus   electrons All light, including laser light, is made up of little packets called  photon s .  Photons aren't all alike, they can be different colors or contain different  amounts of energy. ~ 0.1mm
Arabian physicist ,  Alhazen , in the  Book of Optics , held  light  rays to be streams of minute  energy particles , The process which makes lasers possible, Stimulated Emission, was proposed in  1917 by Albert Einstein .  1960 that the first true laser was made by  Theodore   Maimam , out of synthetic ruby كان  " أينشتين "  Einstien  أول من تنبأ في عام  1916 م بأن الإلكترونات تستطيع أن تطلق نوعاً خاصاً من الضوء، فعندما سقط ضوء المصباح على الياقوتة أهاج ذراتها، وانبعث منها وميض انتشر إلى طرفيها ليصطدم بالفضة التي عكسته كالمرآة، فتردد ذهاباً وإياباً، فزادت قوته وتركيزه، وانطلق شعاع لامع من الضوء الأحمر من نوع غير معهود من قبل ا
تضخيم الضوء بواسطة الأنبعاث المحفز  للأشعة . ,[object Object],عبارة عن حزمة ضوئية ذات  فوتونات  تشترك في ترددها وتتطابق موجاتها بحيث تحدث ظاهرة  التداخل البناء  بين موجاتها لتتحول إلى نبضة ضوئية ذات طاقة عالية  والليزر هو حزمة من الضوء المكثف يسير باتجاه مستقيم عكس الضوء الاعتيادي الذي ينتشر بكل الأتجاهات وبأطوال موجية ,[object Object],[object Object],Emission   .  The excited atom emits a photon when another photon comes by.  In 1917, Einstein described this process as Stimulated  Emission radiation  refers to the photons which are being emition Light   is energy people can see .  جهاز الليزر عبارة عن مصدر للضوء، يعمل على تجميع الإشعاعات الضوئية، التي تتولد داخل الجهاز، وتركيزها، وتقويتها، على شكل حزمة ضوئية رفيعة جداً في اتجاه واحد مركز، وهي أشعة كهرومغناطيسية متجانسة   coherent  ومتماسكة، وتستطيع قطع مسافات لا نهائية في خط مستقيم .  وتتميز بأنها تزداد شدتها، ويقوي بعضها بعضاً عند الانطلاق تتألف كلمة ليزر من الحروف الأولى لأسم هذه الأشعة بالغة الإنجليزية الذي يعني
 
What is Laser Therapy? ,[object Object],[object Object],[object Object],[object Object],يتميز شعاع الليز ر ، أي كانت مادته أو منطقة طيفه ، بالخواص الرئيسية التالية   :- ]  أحادي اللون  Monochromatic  ،   أي ذو عرض طيفي ضيق ينتج عنه تردد مفرد نقي ،  ]  توازي الحزم الضوئية  COLLIMATION   ،  أي  يكاد التشتت أو التفريق في الحزمة يكون معدوما ]   الترابط  Coherence  ،  الترابط بين موجات الحزمة الواحدة مكانياً وزمانياً  يساعد الموجات الضوئية أو الفوتونات في تقوية بعضها البعض لتعطي طاقة وقدرة عالية للحزمة الواحدة ا ]  الشدة  Intensity  ،  شدة الشعاع عالية ومركزة في خزمة ذات قطر ضيق لا يتجاوز الواحد مليمتر   ، وعند استخدام البصريات الملائمة يمكن تعريضها وفق الحاجة  . للحصول على أشعة الليزر من الضروري توفر ثلاثة شروط أساسية وهي  : 1)  حدوث التعداد المعكوس   . 2)  توفر الانبعاث المحتث  . 3)  إيحاد التكبير الضوئي   . Definition:   "Laser therapy” is  any treatment using intense beams of light to  precisely cut, burn, or destroy tissue ,[object Object],[object Object],[object Object],[object Object]
CONSTRUCTION Principal components: 1.Active laser medium 2.Laser pumping energy 3.Mirror(100%) 4.Mirror(99%) 5.Laser beam هذا شكل يوضح أجزاء جهاز الليزر  .  (1)  الوسط المنتج لشعاع الليزر  . (2 )  طاقة كهربائية لتحفيز الوسط على أصدار الموجات الضوئية  .  وعاكس  (3)  للضوء عال الأداء  .  وعدسة (4)  خروج الشعاع وقد تكون مستوية أوعدسة مقعرة .  5) شعاع الليزر الناتج  ليزر الغاز   (  CO 2  laser,Excimer LASER)  لي زر السائل   ()  ليزر اشباه الموصلات   ( Semiconductor LASER)  ليزر الحالة الصلبة   ( نيوديميوم ياغ  Neodymium-YAG LASER)  المواد القادرة على اطلاق اشعة الليزر  منها  المتجمدة   ( الياقوت الاحمر  و  زجاج النيوديميوم ) , والغازية ( الهيليوم   والنيون   والزينون )  مواد شبه موصلة  ( زرنيخ ,  الجاليوم  و  انتيمون الانديوم )
 
 
APPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of eye surgeries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy of the Eye L I G H T
RK : Radial keratotomy PRK : Photorefractive keratectomy LASIK : Laser assisted in-situ keratomileusis LASEK : Laser epithelial keratomileusis ICRS : Intra-corneal ring segments Lens exchange : following removal of a cataractous or clear lens Phakic IOL  (intraocular lens placed in the eye in addition to the crystalline lens LTK : Holmium laser thermokeratoplasty DTK  Diode thermokeratoplasty AK : Arcuate Keratotomy Reffractive   surgery
History of Laser Refractive Surgery
NEARSIGHTEDNESS FARSIGHTEDNESS ASTIGMATISM REFRACTIVE ERRORS
70%  of the eye's  focusing power  comes  from the  cornea   and  30% from the  l ens .
In most cases,  refractive surgery affects  the shape of your  cornea  to redirect how light is focused onto the retina.  Popular procedures  include LASIK, LASEK, PRK and CK . For myopia , your corneal tissue is removed centrally in a lenticular (lens-like) pattern,  thereby  flattening the central cornea and reducing the eye’s focusing power to correct your refractive error For hyperopia , your corneal tissue is removed around the edges, thereby steepening the central cornea and increasing the eye’s focusing power. For astigmatism,  your corneal tissue removed in a precise elliptical pattern which steepens the cornea where it is too flat and flattens the cornea where it is  too steep, thereby accurately  correcting your refractive error .
The first in the line of laser procedures for vision correction was  Photorefractive   Keratectomy  or  PRK.   PRK  is performed with an  excimer laser , which uses a  cool ultraviolet light  beam to ablate tiny bits of corneal surface tissue. sculpt an area of  5 to 9 millimeters  in diameter on the surface of the eye .   PRK  is still the laser vision correction treatment of choice for many eye surgeons for patients with larger pupils and thin corneas .  PRK can effectively improve myopia, hyperopia, and astigmatism . First invented in the early 1980�s, PRK received FDA approval in 1995
مد البصر– حرج البصر Astigmātisma H y permetrop ia
[object Object],[object Object],[object Object],Pachymetry measures corneal thickness  The Epi-microkeratome is used in the Epi-LASIK procedure
LASIK , or Laser Assisted In Situ Keratomileusis for people with corneas to thin or too flat
LASIK Laser Eye Surgery  LASIK  is an acronym for  LAS er  I n-situ  K eratomileusis, which simply means "to shape the cornea within using a laser."
Surface Ablation ,[object Object],[object Object],[object Object],[object Object],[object Object],2007 年 04 月 15 日  中國上海國際眼科學術會暨兩岸論壇
Risks ,[object Object],[object Object],[object Object],[object Object],[object Object],Clear natural  vision E xpanded recreational opportunities E xpanded career opportunities (Pilot, Police, Military, etc ) Elimination of risks of infection, and inflammation associated  w ith contact lens overuse. Benefit s
[object Object]
INTRALASIK   ,[object Object]
Preoperative: Patients wearing soft contact lenses typically are instructed to stop wearing them approximately 7 to 10 days before surgery.   The day before surgery, you should stop using: •  creams  •  lotions  •  makeup  •  perfumes   ,[object Object],[object Object],[object Object],[object Object],[object Object],The  flap  can be dislodged by any direct injury to the eye after treatment.  Clarity and quality of vision  can de diminished if flap conditions occur.  Poor night vision  is the most common side effect.   Light sensitivity A   subconjunctival hemorrhage   is a common and  minor post-LASIK complication. ,[object Object],Factors affecting surgery
Advantages of LASIK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epi-Lasik ,[object Object],patients with very thin corneas or for individuals who participate in high-contact sports or professions
2006 年 10 月 28 日  中國廈門屈光手術研討會 Epi-LASIK
Epi-LASEK Laser Eye Surgery ,[object Object],The Treatment After Treatment Bandage Lenses Possible Side Effects الطبقة بسماكة تتراوح بين  130 الى  180 مايكرونا، وهذه الطبقة شبه دائرية حيث يبقى لها ما يشبه المفصل تقلب حوله ويعمل الليزر لتصحيح
Faster healing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 1 pre- and postoperatively Mike P. Holzer, MD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Femtosecond lasers assisted penetrating keratoplasty Mike P. Holzer, MD A B C Femtec  (20/10 Perfect Vision, Germany)  femtosecond laser (A) which was used for cut of donor and recipient cornea (B). Preparation of corneal donor button (C).
But now, a new approach to refractive surgery-   Wavefront Guided Custom LASIK-   Instead of just correcting defocus (spherical and cylindrical) errors, we can now take a wavefront image- literally a  'fingerprint'  of each person's optical pathway- and use the information to reduce or even eliminate higher order aberrations.  not only improve how much a person sees , but also  the quality of vision  in terms of improvement in contrast sensitivity and fine detail. Risk of  post-Lasik complications, such  as  glare ,  halos , and  poor night vision , are significantly reduced, and if these conditions are pre-existing they can often be treated with Wavefront Lasik procedures.
Glaucoma ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],The same view with advanced vision loss from glaucoma A normal range of vision .
TREATMENT ,[object Object],[object Object]
 
Cataract surgery ,[object Object],[object Object],Light passes through the clear lens implant
[object Object],Laser makes a small hole in the capsule. Light can then pass directly onto the retina, without being scattered. LASER TREATMENT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Floaters after laser capsulotomy
Laser Treatment Highly Effective in Treating  Diabetic Retinopathy ,[object Object],[object Object],[object Object],[object Object],Scatter (pan-retinal) photocoagulation  : Scatter treatment is used to slow the growth of new abnormal blood vessels that have developed over a wide area of the retina. The ophthalmologist may make hundreds of laser burns on the retina to stop the blood vessels from growing   Panretinal treatment  reduces growth  of new capillaries throughout the retina.
Diabetic retinopathy Neovascularization Hemorrhage
AGE RELATED MACULAR DEGENERATION
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Visual acuity
THANK YOU
[object Object]
[object Object],[object Object]
[object Object]
[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Poor candidates for LASIK
Stromal opacity post LASIK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Penicillium sp. ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maculopathies & LASIK    Frequency of MH and  SF-CNV 0.02%   0.01% Myopia is a risk factor for MH formation  0.5-1.3% in > -8 D LASIK does not seem to increase the incidence of MH and SF-CNV in myopes LASIK is a safe procedure with a low incidence of vitreo-retinal complications
 
 

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Presention

  • 1. OCULAR LASER THERAPY الليزر وتطبيقاته في مجال طب العين اعداد : الدكتور محمد منير الشنواني - الرقه
  • 2. الله نور السماوات والارض Lasers are a kind of light that is different than light from the sun,
  • 3. There are also kinds of energy which are invisible to people's eyes Light is energy people can see infrared - this energy can't be seen but is able to be felt as heat radio - people can't see this energy , b ut radio's can turn it into s oun d microwave - this energy can be used to cook food But there are photons which have a wavelength that is just right for the human eye to see. النانومتر هو جزء من مليار جزء من المتر one millionth of a millimetre 1 nanometre = فمتومتر | أنغستروم | نانومتر | ميكرومتر | مليمتر | سينتمتر | ديسيمتر | متر | ديكامتر | هيكتومتر | كيلومتر
  • 4. عندما يجري تحفيز جهاز الليزر ترتفع طاقة ذراتها من المستوى الادنى إلى المستوى الاعلى ،وتعاود الانخفاض إلى مستوى الطاقة الادنى مرورا بالمستوى الأوسط نتيجة عدم استقرار الجسيمات الواقعة في مسار الطاقة ، عندها تنبعث ا لفوتونات التي تعطي رنينا في جهاز الليزر وتخرج من الجهاز بطاقة كبيرة وصلت اقصى ما وصلت اليه 1700 مليون ميجاواط و يتم التفاعل في ثلاثة على عشرة ملايين ثانية وضغطها مليون وخمسين الف كيلو جرام على السنتيمتر ا لمربع ودرجة الحرارة بين 100-200 الف درجة ). BOHR ATOM´S MODEL nucleus electrons All light, including laser light, is made up of little packets called photon s . Photons aren't all alike, they can be different colors or contain different amounts of energy. ~ 0.1mm
  • 5. Arabian physicist , Alhazen , in the Book of Optics , held light rays to be streams of minute energy particles , The process which makes lasers possible, Stimulated Emission, was proposed in 1917 by Albert Einstein . 1960 that the first true laser was made by Theodore Maimam , out of synthetic ruby كان " أينشتين " Einstien أول من تنبأ في عام 1916 م بأن الإلكترونات تستطيع أن تطلق نوعاً خاصاً من الضوء، فعندما سقط ضوء المصباح على الياقوتة أهاج ذراتها، وانبعث منها وميض انتشر إلى طرفيها ليصطدم بالفضة التي عكسته كالمرآة، فتردد ذهاباً وإياباً، فزادت قوته وتركيزه، وانطلق شعاع لامع من الضوء الأحمر من نوع غير معهود من قبل ا
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  • 9. CONSTRUCTION Principal components: 1.Active laser medium 2.Laser pumping energy 3.Mirror(100%) 4.Mirror(99%) 5.Laser beam هذا شكل يوضح أجزاء جهاز الليزر . (1) الوسط المنتج لشعاع الليزر . (2 ) طاقة كهربائية لتحفيز الوسط على أصدار الموجات الضوئية . وعاكس (3) للضوء عال الأداء . وعدسة (4) خروج الشعاع وقد تكون مستوية أوعدسة مقعرة . 5) شعاع الليزر الناتج ليزر الغاز ( CO 2 laser,Excimer LASER) لي زر السائل () ليزر اشباه الموصلات ( Semiconductor LASER) ليزر الحالة الصلبة ( نيوديميوم ياغ Neodymium-YAG LASER) المواد القادرة على اطلاق اشعة الليزر منها المتجمدة ( الياقوت الاحمر و زجاج النيوديميوم ) , والغازية ( الهيليوم والنيون والزينون ) مواد شبه موصلة ( زرنيخ , الجاليوم و انتيمون الانديوم )
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  • 14. Anatomy of the Eye L I G H T
  • 15. RK : Radial keratotomy PRK : Photorefractive keratectomy LASIK : Laser assisted in-situ keratomileusis LASEK : Laser epithelial keratomileusis ICRS : Intra-corneal ring segments Lens exchange : following removal of a cataractous or clear lens Phakic IOL (intraocular lens placed in the eye in addition to the crystalline lens LTK : Holmium laser thermokeratoplasty DTK Diode thermokeratoplasty AK : Arcuate Keratotomy Reffractive surgery
  • 16. History of Laser Refractive Surgery
  • 18. 70% of the eye's focusing power comes from the cornea and 30% from the l ens .
  • 19. In most cases, refractive surgery affects the shape of your cornea to redirect how light is focused onto the retina. Popular procedures include LASIK, LASEK, PRK and CK . For myopia , your corneal tissue is removed centrally in a lenticular (lens-like) pattern, thereby flattening the central cornea and reducing the eye’s focusing power to correct your refractive error For hyperopia , your corneal tissue is removed around the edges, thereby steepening the central cornea and increasing the eye’s focusing power. For astigmatism, your corneal tissue removed in a precise elliptical pattern which steepens the cornea where it is too flat and flattens the cornea where it is too steep, thereby accurately correcting your refractive error .
  • 20. The first in the line of laser procedures for vision correction was Photorefractive Keratectomy or PRK. PRK is performed with an excimer laser , which uses a cool ultraviolet light beam to ablate tiny bits of corneal surface tissue. sculpt an area of 5 to 9 millimeters in diameter on the surface of the eye . PRK is still the laser vision correction treatment of choice for many eye surgeons for patients with larger pupils and thin corneas . PRK can effectively improve myopia, hyperopia, and astigmatism . First invented in the early 1980�s, PRK received FDA approval in 1995
  • 21. مد البصر– حرج البصر Astigmātisma H y permetrop ia
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  • 23. LASIK , or Laser Assisted In Situ Keratomileusis for people with corneas to thin or too flat
  • 24. LASIK Laser Eye Surgery LASIK is an acronym for LAS er I n-situ K eratomileusis, which simply means "to shape the cornea within using a laser."
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  • 32. 2006 年 10 月 28 日 中國廈門屈光手術研討會 Epi-LASIK
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  • 36. Femtosecond lasers assisted penetrating keratoplasty Mike P. Holzer, MD A B C Femtec (20/10 Perfect Vision, Germany) femtosecond laser (A) which was used for cut of donor and recipient cornea (B). Preparation of corneal donor button (C).
  • 37. But now, a new approach to refractive surgery- Wavefront Guided Custom LASIK- Instead of just correcting defocus (spherical and cylindrical) errors, we can now take a wavefront image- literally a 'fingerprint' of each person's optical pathway- and use the information to reduce or even eliminate higher order aberrations. not only improve how much a person sees , but also the quality of vision in terms of improvement in contrast sensitivity and fine detail. Risk of post-Lasik complications, such as glare , halos , and poor night vision , are significantly reduced, and if these conditions are pre-existing they can often be treated with Wavefront Lasik procedures.
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  • 47. AGE RELATED MACULAR DEGENERATION
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  • 66. Maculopathies & LASIK Frequency of MH and SF-CNV 0.02% 0.01% Myopia is a risk factor for MH formation 0.5-1.3% in > -8 D LASIK does not seem to increase the incidence of MH and SF-CNV in myopes LASIK is a safe procedure with a low incidence of vitreo-retinal complications
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