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Intrastromal Keratomileusis: All Femtosecond Laser Refractive Surgery (pp. 281-296) $100.00
Authors:  (Anders H. Vestergaard, Anders R. Ivarsen and Jesper Ø. Hjortdal, Department of Ophthalmology, Aarhus University Hospital, Denmark, and others)
In 2001 the femtosecond (FS) laser was introduced in refractive surgery. Its main
application has been as a replacement to the microkeratome when creating the corneal
flap in one of the most common surgical procedures in the world, laser in situ
keratomileusis (LASIK), for treatment of myopia (nearsightedness). It is also used for
treatment of astigmatism after corneal transplants, to create incisions for intra corneal
rings and lamellar transplants, and lately in cataract surgery. The FS laser uses ultra fast
(10-15) pulses to create photo disruption at its focal point to produce high precision tissue
cleavage with minimum collateral damage.
With the introduction of the VisuMax FS laser in 2006, surgical removal of corneal
tissue was re-invented in the shape of refractive lenticule extraction, or ReLEx®. Two
new procedures were developed, ReLEx flex (flex) and ReLEx smile (smile), in which a
lenticule is cut within the cornea by the FS laser and manually extracted. In flex, a
LASIK-like flap is used to access the stromal lenticule. In smile, only one or two small
incisions are made, minimizing trauma to the corneal surface. Theoretically, this should
reduce corneal denervation, postoperative dry eye sensation, and enhance biomechanical
stability as compared to flap-related procedures, such as LASIK. This chapter will
hopefully give the reader an overview of the existing knowledge and literature
concerning treatment of refractive errors using the all femtosecond laser based flex and
smile techniques. 

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Intrastromal Keratomileusis: All Femtosecond Laser Refractive Surgery (pp. 281-296)