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Profesor doktor Vladimir Kojoviċ: Lasersko skidanje dioptrije - druga strana medalje

post objavio/la reuw prije 9 godina 2 mjeseca na blogu Oftalmologija - Leksikon pojmova od A-Ž

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ima bih dva pitanja:

1. negdje na pocetku teksta gdje se govori o mogucim komplikacijama nalazi se i ovo:
"Smatra se da one iznose oko 1-2% ili da jedan od sest operisanih pacijenata ima neku od mogucih komplikacija."

po kojoj racunici je 1-2% jednako "jedan od sest"? ja bih rekao da je 1/6 ustvari 16.66%. ili mozda grijesim?

2. tekst je posvecen LASIK metodi. da li isto (ili bolje/gore) stoji sa PRK metodom?

hvala za odgovor.

Objavio/la cryptoman prije 9 godina 2 mjeseca #

Pod 1, odgovaram umjesto profesora Kojovica, mozda on kaze drugacije Jedna od komplikacija se pojavljuje kod 2 posto,a ako ima osam razlicitih komplikacija * a ima,znaci da ima 16 posto pacijenata koji imaju jednu od komplikacija.

pod 2, pogledaj to jest>

Pros and Cons of PRK vs. LASIK

PRK has one distinct advantage over LASIK: because no corneal flap is created, there is no risk of flap complications during or after the procedure.

This may be important for people who are engaged in activities that put them at risk for eye injuries (and potentially, LASIK flap dislocations) after surgery. Boxing and martial arts are good examples.

PRK also can be performed safely on corneas that may be too thin for LASIK. Since no LASIK-style flap is required, the entire thickness of the underlying corneal stroma is available for treatment. A person who has PRK surgery rather than LASIK will have a thicker residual "stromal bed" after the excimer laser treatment.

In LASIK, on the other hand, the corneal flap contains both epithelial and stromal tissues, so the underlying corneal stroma is reduced in thickness. The same amount of excimer laser reshaping with LASIK leaves less residual stroma under the corneal flap, which may affect the biomechanical strength and stability of the eye in some cases.

Excimer laser treatments that cause too much reduction in the residual stromal bed have been indicated as a potential cause of a serious LASIK complication called corneal ectasia, which can severely distort vision and cause permanent vision loss.

It's important to know that PRK causes more discomfort than LASIK the first few days after surgery, and complete visual recovery after PRK surgery can take a few weeks longer than LASIK recovery time.

There also is a greater risk of eye infection immediately after PRK compared with LASIK, and a greater risk of temporary or permanent haziness of the cornea that may affect vision.
The PRK Procedure

The basic steps in PRK surgery are:

Anesthetic eye drops are applied to the eye to prevent discomfort during surgery.
A central area of corneal epithelium is removed — either with a laser or manually after being softened with a dilute alcohol solution.
An excimer laser is used to reshape the underlying corneal tissue.
Antibiotic and anti-inflammatory drops are applied to the eye, and the eye is covered with a bandage contact lens.

Two or three days later (after the epithelium has had a chance to grow back), the bandage contact lens is removed.
Considerations After PRK Surgery

Before consenting to PRK surgery, be aware that:

PRK causes more post-operative discomfort than LASIK. This may last for a week or longer.
It can take three to six months to achieve optimal vision after PRK. Blurred vision, glare and sensitivity to light are common for several days or longer after the procedure.
Due to the potential for blurred vision for a time after PRK, surgeons often perform PRK on one eye at a time (waiting several days or weeks to perform PRK on the other eye, after vision in the first eye is acceptably clear).
You may be required to use medicated eye drops for up to six months after PRK to prevent or reduce corneal haze or scarring.

PRK Risks and Complications

As with LASIK and other types of refractive surgery, there are risks and possible complications associated with PRK. These risks and complications of PRK are similar to those of LASIK, and include:

Dry eyes
Vision problems, such as poor night vision, glare, halos and haze
Incomplete or inaccurate vision correction
Infection following surgery

There may be a slightly greater risk of eye infection, scarring, glare and unpredictable healing of the cornea after PRK compared to LASIK. But serious complications following PRK are rare.
PRK Cost

The cost of PRK is comparable to the cost of LASIK eye surgery. Like LASIK and other laser vision correction surgery, PRK is considered an elective procedure and therefore costs associated with the surgery typically are not covered by health insurance.

You can lower your PRK costs by setting up a Health Savings Account (HSA) at your bank or contributing to flexible health benefits program at work.

Many refractive surgeons also offer financing programs that allow you to pay for PRK and other vision correction procedures over time at attractive interest rates or interest-free.
Other PRK Facts

Here are a few other PRK facts to consider:

PRK has been performed longer than LASIK. It gained FDA approval for use in the United States for the correction of nearsightedness in 1995 and for the treatment of farsightedness in 1998.
Studies show the visual results of PRK and LASIK six months after surgery are comparable. (But vision returns to normal faster after LASIK, with less post-operative discomfort.)
PRK typically is used to correct up to -7.00 diopters (D) of nearsightedness and up to +4.00 D of farsightedness, with or without astigmatism.
During PRK, the excimer laser can be programmed to deliver a standard laser treatment (or ablation) or a customized, wavefront-guided ablation, like that used for wavefront LASIK.

Because PRK eliminates the risk of flap complications, some refractive surgeons prefer PRK to LASIK for many patients, especially those with marginally thin corneas.

PRK also is recommended by many surgeons to improve vision after cataract surgery and previous refractive procedures on the same eye, including radial keratotomy (RK), refractive lens exchange (RLE) and phakic IOL implantation.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

Objavio/la reuw prije 9 godina 2 mjeseca #

hvala za pojasnjenje.

Objavio/la cryptoman prije 9 godina 2 mjeseca #


1. LASIK causes dry eye
Dry eye is the most common complication of LASIK. Corneal nerves that are responsible for tear production are severed when the flap is cut. Medical studies have shown that these nerves never return to normal densities and patterns. Symptoms of dry eye include pain, burning, foreign body sensation, scratchiness, soreness and eyelid sticking to the eyeball. The FDA website warns that LASIK-induced dry eye may be permanent. Approximately 20% of patients in FDA clinical trials experienced "worse" or "significantly worse" dry eyes at six months after LASIK.(1)

2. LASIK results in loss of visual quality
LASIK patients have more difficulty seeing detail in dim light (loss of contrast sensitivity) and experience an increase in visual distortion at night (multiple images, halos, and starbursts). A published review of data for FDA-approved lasers found that six months after LASIK, 17.5 percent of patients report halos, 19.7 percent report glare (starbursts), 19.3 percent report night-driving problems and 21 percent complain of eye dryness.(1) The FDA website warns that patients with large pupils may suffer from debilitating visual symptoms at night.

3. The cornea is incapable of complete healing after LASIK
The flap never heals. Researchers found that the tensile strength of the LASIK flap is only 2.4% of normal cornea.(2) LASIK flaps can be surgically lifted or accidentally dislodged for the remainder of a patient’s life. The FDA website warns that patients who participate in contact sports are not good candidates for LASIK.

LASIK permanently weakens the cornea. Collagen bands of the cornea provide its form and strength. LASIK severs these collagen bands and thins the cornea.(3) The thinner, weaker post-LASIK cornea is more susceptible to forward bulging due to normal intraocular pressure, which may progress to a condition known as keratectasia and corneal failure, requiring corneal transplant.

4. There are long-term consequences of LASIK
• LASIK affects the accuracy of intraocular pressure measurements,(4) exposing patients to risk of vision loss from undiagnosed glaucoma.

• Like the general population, LASIK patients will develop cataracts. Calculation of intraocular lens power for cataract surgery is inaccurate after LASIK.(5) This may result in poor vision following cataract surgery and exposes patients to increased risk of repeat surgeries. Ironically, steroid drops routinely prescribed after LASIK may hasten the onset of cataracts.

• Research demonstrates persistent decrease in corneal keratocyte density after LASIK.(6) These cells are vital to the function of the cornea. Ophthalmologists have speculated that this loss might lead to delayed post-LASIK ectasia.

5. Bilateral simultaneous LASIK is not in patients’ best interest
In a 2003 survey of American Society of Cataract and Refractive Surgery (ASCRS) members,(7) 91% of surgeons who responded did not offer patients the choice of having one eye done at a time. Performing LASIK on both eyes in the same day places patients at risk of vision loss in both eyes, and denies patients informed consent for the second eye. The FDA website warns that having LASIK on both eyes at the same time is riskier than having two separate surgeries.

6. Serious complications of LASIK may emerge later
The medical literature contains numerous reports of late-onset LASIK complications such as loss of the cornea due to biomechanical instability, inflammation resulting in corneal haze, flap dislocation, epithelial ingrowth, and retinal detachment.(8) The LASIK flap creates a permanent portal in the cornea for microorganisms to penetrate, exposing patients to lifelong increased risk of sight-threatening corneal infection.(9) Complications may emerge weeks, months, or years after seemingly successful LASIK.

7. LASIK does not eliminate the need for glasses
Since LASIK does not eliminate the need for reading glasses after the age of 40 and studies show that visual outcomes of LASIK decline over time,(10) LASIK patients will likely end up back in glasses – sometimes sooner rather than later.

8. The true rate of LASIK complications is unknown
There is no clearinghouse for reporting of LASIK complications. Moreover, there is no consensus among LASIK surgeons on the definition of a complication. The FDA allowed laser manufacturers to hide complications reported by LASIK patients in clinical trials by classifying dry eyes and night vision impairment as "symptoms" instead of complications.(1)

9. Rehabilitation options after LASIK are limited
LASIK is irreversible, and treatment options for complications are extremely limited. Hard contact lenses may provide visual improvement if the patient can obtain a good fit and tolerate lenses. The post-LASIK contact lens fitting process can be time consuming, costly and ultimately unsuccessful. Many patients eventually give up on hard contacts and struggle to function with impaired vision. In extreme cases, a corneal transplant is the last resort and does not always result in improved vision.

10. Safer alternatives to LASIK exist
Some leading surgeons have already abandoned LASIK for surface treatments, such as PRK, which do not involve cutting a corneal flap. It is important to remember that LASIK is elective surgery. There is no sound medical reason to risk vision loss from unnecessary surgery. Glasses and contact lenses are the safest alternatives.


1. Bailey MD, Zadnik K. Outcomes of LASIK for myopia with FDA-approved lasers. Cornea. 2007 Apr;26(3):246-54.

2. Schmack I, Dawson DG, McCarey BE, Waring GO 3rd, Grossniklaus HE, Edelhauser HF. Cohesive tensile strength of human LASIK wounds with histologic, ultrastructural, and clinical correlations. J Refract Surg. 2005 Sep-Oct;21(5):433-45.

3. Jaycock PD, Lobo L, Ibrahim J, Tyrer J, Marshall J. Interferometric technique to measure biomechanical changes in the cornea induced by refractive surgery. J Cataract Refract Surg. 2005 Jan;31(1):175-84.

4. Cheng AC, Fan D, Tang E, Lam DS. Effect of Corneal Curvature and Corneal Thickness on the Assessment of Intraocular Pressure Using Noncontact Tonometry in Patients After Myopic LASIK Surgery. Cornea. 2006 Jan;25(1):26-28.

5. Wang L, Booth MA, Koch DD. Comparison of intraocular lens power calculation methods in eyes that have undergone laser-assisted in-situ keratomileusis. Trans Am Ophthalmol Soc. 2004;102:189-96.

6. Erie JC, Patel SV, McLaren JW, Hodge DO, Bourne WM. Corneal keratocyte deficits after photorefractive keratectomy and laser in situ keratomileusis. Am J Ophthalmol. 2006 May;141(5):799-809.

7. Leaming DV. Practice styles and preferences of ASCRS members--2003 survey. J Cataract Refract Surg. 2004 Apr;30(4):892-900.

8. MEDLINE database of citations and abstracts of biomedical research articles. PubMed

9. Vieira AC, Pereira T, de Freitas D. Late-onset infections after LASIK. J Refract Surg. 2008 Apr;24(4):411-3.

10. Zalentein WN, Tervo TM, Holopainen JM. Seven-year follow-up of LASIK for myopia. J Refract Surg. 2009 Mar;25(3):312-8.

Objavio/la reuw prije 9 godina 1 mjesec #

mnogo toga iz ovog teksta stoji, samo neke stvari se rijetko navode, recimo amerikanci koriste losije lasere nego u europi jer FDA stiti njihovu industriju, bar su mi tako rekli kad sam pricao s nekim refraktivnim kirurzima, drugo mislim da bi svatko trebao pitat refraktivnog kirurga par pitanja:
1. koliko ste zahvata napravili, pozeljno da se broji u stotinama ili tisucama
2. koliko ste ljudi odbili, 1 odbijeni u našim klinikama je oko 1500 € iz djepa van, a na neki nacin smanjen rizik, pozeljno da se odbije bar 5% pacijenata, jer kirurginja s kojom sam pricao a napravila je oko 3000 zahvata kaze, na preop pregledu ti izračunaš na temelju nalaza i koliko će rožnice ostati i kolika će biti keratometrija (to mi je na mom primjeru objasnila jer sam se bojao oko problema s nocnim vidom), ljudi misle da oni samo upisu brojeve u masinu, al te masine rade sve sta im se naredi a to je vec ipak nesto sto dolaiz iz iskustva
3. lasik je laksi pacijentu, a kirurgu je cak i jeftiniji, jer kod lasika ima potrosnog materijala u obliku mikrokeratoma koji koštaju i po 200€ za oko, ja sam iskreno bio pacijent iz pakla jer sam procitao pola interneta 10 puta i uvjeren sam bio da je za mene PTK pa PRK najbolja metoda... al kad porpicas s nekime tko je stvarno strucan i tko to radi shvatis da mozda i nisu blesavi... Naime kako mi je rečeno PRK daje manje predvidive rezultate i veća je šansa povrata dioptrije

operacija bila bezbolna, prvi dan pjesak u ocima, nisam bio discipliniran bas s kapima ali uopce nemam nekih posljedica. nemam ni halo, ni starburst, ni glare, baš niti jednu nuspojavu, oko mi je vratilo prirodnu vlagu nakon samo 5 dana tako da me to odusevilo

Objavio/la Gost_2136 prije 9 godina 1 mjesec #

dobar komentar. Jedan od uspjesnih. Preoperativna PROCJENA je izuzetno vazna i na to treba utrositi dosta vremena koga obicno doktori nemaju. Da, masine sve izracunaju, ali je pitanje kako se "nahrane". Sama operacija nije teska i sretni ste ako sve prodje OK. A ako upadnete u onu manju skupinu koja je radi toga nesretna i uz to ostali bez para, a ne mogu nista jer su potpisali da su im objasnjene sve moguce komplikacije...e onda je prica drukcija. Na srecu takvih je manje od onih sretnika koji su prosli OK. Sta reci: licna odluka, a ko je zadovoljan sa KL ili Naocalima ...hvala , laser NE

Objavio/la Gost_6997 prije 9 godina 1 mjesec #


Ja sam dr Bojan Kozomara, oftalmolog iz Klinike Svjetlost iz Banjaluke. Moj otac je takođe oftalmolog, prof. Risto Kozomara.
Ne shvatam potrebu da sve što je novo i revolucionarno kod naših ljudi mora biti oblaćeno!
Lasersko skidanje dioptrije je POTPUNO SIGURNA METODA, koja se u razvijenom svijetu primjenjuje od 1960. godine, a na laserima najnovije generacije i sa najnovijim operativnim tehnikama od 1990. godine. I sam sam bio pacijent i skinuo svoju dioptriju 2009. godine. Bio sam visoko kratkovidan, do tada nosio naočale i kontaktna sočiva, dobijao česte upale rožnjače (keratitise) od nošenja sočiva i postao intolerantan na njih. Svojim primjerom i sa željom da sebe riješim potrebe za nošenjem naočala i sočiva uradio sam ovu operaciju, kao i još 5 mojih kolega iz klinike Svjetlost.
Sad bih ja postavio nekoliko pitanja vama:
1. Zar je moguće da je NASA prihvatila operaciju metodom LASIK još 2007. godine kao potpuno sigurnu metodu i preporučila je svim svojim astronautima da je urade kako bi mogli napredovati u svojim karijerama (za one poslove za koje je potrebna odlična vidna oštrina)?
2. Zar je moguće da je Američka vojska, odnosno vazduhoplovstvo, savjetovalo svojim pilotima da urade ovu operaciju kako bi mogli napredovati u svojim karijerama, a da pri tome nema opasnosti po vid ili oko?
3. Zašto cijenjeni prof. Kojović nije napisao koji tekst o istraživanjima FDA o štetnosti nošenja kontaktnih sočiva na endotel i epitel rožnjače oka?
4. Zašto nije objasnio šta je to hipoksija oka, Acantamoeba keratitis, koliku štetu upale oka nastale nošenjem kontaktnih sočiva mogu izazvati na oku?

Nema niti jedne medicinske procedure na svijetu koja je 100% sigurna, ali lasersko skidanje dioptije je procedura koja UOPŠTE NIJE OPASNA NITI PO VID, NITI PO OKO! Jer da jeste, moje oči, oči oftalmologa, sigurno ne bi bile operisane. Apsolutno podržavam činjenicu da svako ima pravo da bira da li će se podvrgnuti ovoj operaciji, ili bilo kojoj drugoj operaciji, ili ne.
Svima želim mnogo sreće u životu i radu!

Dr Bojan Kozomara.

Objavio/la Gost_5198 prije 9 godina #

Zao mi je da prijem moje operacije laserskog skidanja dioptrijen nisam imao priliku procitati nista o mogucim komplikacijama. Imao sam dioptriju oko -4.0 i dojadilo mi je nosenje leca. Kod poznatog doktora iz Zagreba sam uradio pregled koji je trajao desetak minuta i uradio mi je operaciju . Kratko i bezbolno. Od tada do danas se mucim sa suvocom ociju, zamagljenjem vida, uvece kada vozim moram staviti naocale -1.0, stavljam vjestacke suze 2-3 puta na dan. Nazalost „upao“ sam u onaj postotak mogucih komplikacija. Imam prijatelje koji su zadovoljni operacijom, ali ovo je moja prica. Odluka da se uradi operacija je velika i treba dobro i prouciti problem i razmisliti...eto toliko do mene

Objavio/la Gost_2942 prije 9 godina #

Dr Bojanu Kozomari je najbolje odgovorio gost . Inace, Bojane, pozdravi svoga oca, od kolege sa studija i kolege oftalmologa, koji drzi ovaj blog (Dr Cengic Ferid).
Mladost je puna entuzijazma, a sa staroscu prevladava oprez.

Objavio/la reuw prije 8 godina 11 mjeseci #

Kako razmisljam o laserskom skidanju dioptrije, citam sve i svasta izmedju ostalog i ove komentare.
Procitah i ovaj clanak „ druga strana medalje“ i ne nadjoh nista sto je „ blacenje“ ove metode ( gdje nadje samo ovu rijec ). Dr Kozomora,Jr , upada u neke kontradikcije „Lasersko skidanje dioptrije je POTPUNO SIGURNA METODA „, a kasnije u tekstu kaze :“ Nema niti jedne medicinske procedure na svijetu koja je 100% sigurna „ i onda u duhu dobrog marketinga dodaje „ali lasersko skidanje dioptije je procedura koja UOPŠTE NIJE OPASNA NITI PO VID, NITI PO OKO! Jer da jeste, moje oči, oči oftalmologa, sigurno ne bi bile operisane.“ . Ispade da je njegov slucaj mjerilo svih uspjeha i neuspjeha . A sta je sa ovim pacijentom o kome se pise u nastavku „ druge strane...“
Interesuje me tekst saglasnosti ( consensusa) koji g. Dr. nudi pacijentu prije operacije i da li garantuje 100% uspjeh.
Ono sto me , ko buduceg pacijenta interesuje i sto trazim je da nadjem objektivnog, iskusnog, realnog oftalmologa koji ima dobru opremu i kome dobijeni novac nije jedino mjerilo da mi predlozi operaciju i da mi uradi zaista dobar pregled kako bi se mogucnosti komplikacije svele na najmanje ( Prihvatam da postoji i ta mogucnost ). Svaka sugestija-prijedlog bi dobro dosli.......

Objavio/la Gost_2948 prije 8 godina 11 mjeseci #

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