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Starting from a personal request, I was starting a thread to explain what is LASIK surgery. But then xterm asked about Pulse Dye Laser treatment. Anticipating the fact that there might be more questions about various forms of laser-based surgeries, I'm starting a thread dubbed "Laser Based Surgeries". Upon request, I'll post everything I know about a certain procedure, so please note that my opinion given is based on a biomedical engineer's knowledge unless stated otherwise. Topics will be handeled in FIFO form: first come first serve. So I'll start by LASIK and then move to Pulse Dye Laser treatment.

LASIK Surgery



What does the term LASIK mean? What does it concern?

LASIK is the acronym for "Laser-Assisted in Situ Keratomileusis", where "situ" is latin for "in position" and "keratomileusis" means surgically improving the refractive state of the eye's cornea (changing the shape of the cornea by forming a thin hinged flap). It is the most commonly performed refractive surgery procedure for correcting myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (blurry vision caused by inability of the optics in an eye to focus a point object into a sharp image on retina).

How does it differ from other laser-based optholomy procedures (operation, risks and complications, and recovery rate)?

Other laser-based optholomy procedures include the photorefractive keratecomy (PRK) and Laser-assisted sub-epithelial keratecomy (LASEK; not the same as LASIK). Though PRK and LASEK are technically the same, there are minor diferences: the epthelium (basic type of human/animal tissue that lines cavities like the eye socket and surfaces of structures throughout the body) is removed while treating the layer below with laser in PRK, but in LASEK, an alcoholic solution is used to weaken the structure of the epithelial cells (but not destroyed) so as to fold it, reshape the cornea with laser, and then fold it back into place. When the epithelial flap is viewed to be too weak to return back into original position, it is removed and the LASEK surgery ends up being a PRK surgery.

Advantages of PRK/LASEK over LASIK & LASIK Risks and Complications:
PRK doesn't create a flap in deep cornea tissues, so the integrity of the cornea's structure is more preserved with PRK. Furthermore, it doesn't create the risk of dislocated corneal flaps which may happen at any time with LASIK surgeries (especially after trauma). However, you should note that such complications are extremely rare (at the start in 1995, it was 5%; now, it's below 1%). In case a complication arises, there are medical treatments and corrective surgeries that can be done. Such LASIK surgery complications can be avoided by choosing the right doctor (see sections "Before Surgery" and "What to ask your doctor?"). The right doctor would tell you upfront if you're a good candidate for the surgery or not.

Advantages of LASIK over PRK/LASEK:
LASIK is less painful and has a higher visual recovery rate than PRK/LASEK. Good vision is acheived usually within the next day.

What happens before, during and after surgery?

Before Surgery:

Choose your surgeon wisely. Most post-surgery complications can be avoided by selecting the right surgeon to perform the operation. Your doctor should first conduct an eye exam to determine whether your eyes are healthy enough to go through the procedure (never ever do it before having an eye exam first). The eye exams also reveals what kind of vision correction you would require (though this is obvious already cause of your glasses or contact lens prescriptions) and most importantly how much laser ablation (removal by erosive process) is required. The surgeon should also clear out if you have a case of dry eyes (when you tear film has a certain disorder that doesn't allow proper lubrication of the eye to maintain proper vision and eye comfort) which should be treated before LASIK surgery.As a precaution of developing dry eyes after LASIK, some doctors recommend treatment even if you have a normal tear film.

An ideal surgeon would conduct a corneal topography to develop a detailed map of your cornea and to measure eye curvature. Preferable, it is based on a wavefront analysis system which gives a more detailed and precise map of the cornea and consequently what aberrations are affecting your vision. The wavefront analysis system merely sends light waves to generate this map.

Finally, the surgeon should ask about medications and health conditions, such as diabetes, as they can directly disqualify you from being a good candidate for LASIK surgery.

During Surgery:

I've already explained a bit about it, but a picture is worth a thousand words. A slideshow is even better: http://www.allaboutvision.com/video-library/video-lasik.htm. For those with a strong stomach, you can find a real-time surgery here.

Note that the whole duration of the surgery will not exceed 10 minutes. Your doctor will give you numbing eye-drops (to avoid any discomfort) and sometimes an oral sedative (just to make you loosey-goosey and avoid jittering during the procedure), but you'll be awake the whole time. Have someone with you so they can drive you home afterwards.

After Surgery:

After the surgery, you'll get a few minutes to rest, then you can go home. [/b]Follow your doctor's instructions to the letter: any rest required and medications to take.[/b] It's always better to rest a couple of hours at home after the surgery. Take at least two days off, because streneous activities affect the healing process. Also, avoid exercising for at least a week and avoid rubbing your eye (you don't want to traumatize your eye or dislodge the corneal flap, though slim the chances better be safe than sorry).

Blade Versus Bladeless LASIK

Alot of doctors debate the issue of which method is better: the blade based LASIK surgery (just like seen in the video, where a blade is used to cut the flap in the cornea) or the pure-laser based surgery (where the flap is cut by a laser). In both cases, a laser beam (called the excimer laser, which is a form of ultraviolet laser) will be used to treat the corneal stroma. Though the dual-laser treatment reduces the level of erroneous flap-cutting, both will be penetrating the cornea, so less radiation better than more radiation => Blade-based is my engineerish recommendation. Plus, all-laser treatment is more costy (more radiation exposure = more money payed). Besides, we already agreed that you'll be going to a qualified surgeon with a good reputation to do your surgery, so why should you be scared of erroneous flap-cutting?

The all-laser LASIK procedure emits first femtosecond laser beams (ultrashort pulses; to cut the corneal flap) and then excimer laser beams (to treat the cornea).

What to ask your doctor?

In your consultation appointment, ask the following:

1) What is your complication rate, and how does this compare with national averages? (No it's not a rude question, it's to know more about the surgeon's qualifications. Unfortunately, some doctors have excellent credentials but when I meet them they make me wonder how they survived medical school).
2) Has the surgical center you use ever had an outbreak of serious eye infections? If so, what caused this?
3) If a complication does occur, what is your specific policy regarding follow-up?
4) Do you charge extra if an enhancement is required?
5) If you do charge extra for enhancements, what kind of a price break can be expected?
6) If you don't charge extra for enhancements, what is your cutoff date (one year, for example) for addressing problems after the initial procedure?
7) What excimer laser machine do you use?

What LASIK laser machine is best?

This is directed to those who are interested in knowing what excimer laser machine is best to use for a LASIK surgery. Selecting an excimer laser machine to perform your LASIK surgery is a far-fetched idea. Still, I found this nice comparison table from which I'll select the best (again, acccording to my opinion as an engineer):



Note:

OZ: Optical zone = maximum size of pupil allowing light to pass through the eye that can be targeted effectively for correction with a specific laser.
TZ: Treatment zone = maximum treatment area, including a transition zone that can be used in an ablation to achieve vision correction in the targeted area.

Best machine: Wavelight ALLEGRETTO Wave
Why: Because wave-front guided excimer laser machines are better than normal excimer laser machines: smoothest post-op corneas and the lowest degrees of higher order aberrations in vision. All types of corneal refractive problems are targeted (myopia, hyeropia, and astigmatism). Plus, the scanning beam allows centralization of energy (i.e. the energy is directed to the spot which the surgeon is applying the laser beam at => better results). Finally, it's German, Deutchland: where the elite of design engineers reside.
Alternative: Visx Star S4 IR & CustomVue (commonly used, wave-front guidance, variable scanning beam).

Hope this helps.
Great information, and i watched the video for the surgery taking place. I have a question about it: When the surgery is completed why dont they remove the flap?

As a side note regrading the questions you told us to ask the doc about i dont think they we reply for that in Lebanon, I have tried it and once a doc replied: "Ma shakheltac".
Very nice Mesa thank you. Might I add It would be nice if you could list pairs of hospital/doctors that perform such operations that you know are qualified for such operations (possibly sorted by complication rates)
kareem_nasser wroteWhen the surgery is completed why dont they remove the flap?
The flap is part of the cornea, so it helps in the healing process.
xterm wroteMight I add It would be nice if you could list pairs of hospital/doctors that perform such operations that you know are qualified for such operations (possibly sorted by complication rates)
Actually, I'm already on it, but it's gonna take some time to gather.

PS: I'll try posting what I already found out about pulse dye laser (PDL) tonight (apparently it has the same concept of an IPL which is used for hair removal, and it can be used on infants of ages 2 and 3 days old). I even got a nice information leaflet for parents which was issued by National Health Service (NHS) foundation in 2006. I haven't been able to contact my dermatologist yet, so that issue might take a while. I'm also scouting for health treatment centers who have a PDL (even spas and beauty centers, turns out they use a PDL for removing scars of a tucking job too).
ranibalaa wroteWow.
I second that :)
I am interested in getting eye surgery for myself, I'm sure this will be a good read.
kareem_nasser wroteAs a side note regrading the questions you told us to ask the doc about i dont think they we reply for that in Lebanon, I have tried it and once a doc replied: "Ma shakheltac".
Then be subtle in the way you ask:

1) What is your complication rate, and how does this compare with national averages? =>
"دكتور، في شي حدا صرلو شي بعد العمليه؟ شو البيرسنتج انو يصير في شي تعقيدات بعد العمليه؟ "
2) Has the surgical center you use ever had an outbreak of serious eye infections? If so, what caused this? =>
"سمعت إنت شي انو بصير شي عدوى ببعض الحالات؟"
3) If a complication does occur, what is your specific policy regarding follow-up? &
4) Do you charge extra if an enhancement is required? =>
"إذا لا سمح الله صار في عدوى، مين بغطي تكاليف العلاج؟"
5) If you do charge extra for enhancements, what kind of a price break can be expected? =>
"أديش معئول يكلف العلاج؟"
6) If you don't charge extra for enhancements, what is your cutoff date (one year, for example) for addressing problems after the initial procedure? =>
"بعد كم شهر أو سنه ببطل تكاليف العلاج عل مستشفى؟"
7) What excimer laser machine do you use?
"أديش قوتها للمكنة إلي بتستعملها؟ اللازر مركز كتير؟"

But come to think of it, some doctors don't answer questions truthfully, so you can scout around who did it and ask them the same questions. I'm doing my own research too. Will post results when I get them.

PS: There's a good ophthalmology surgeon called Dr. Walid Harbinger (though it's pronounced حبنجر), he has an office in Salim Salam, and he works two days at Hammoud Hospital in Saida. He most probably does LASIK surgeries:

Contact in Beirut (Yellow Pages):

Clinic in Salim Salam: 01-706668
House in Salim Salam: 01-644226

Contact in Saida (http://hammoudhospital.com/find-a-doctor/):
Main Phone Number
+961-7-723-111
+961-7-720-152
+961-7-732-700- 708

Ophthalmology Ext.
Hani Abou Alfa, MD 1959 8 am – 3 pm Wed 9 am – 12 pm
Ahmad Mokaddam, MD 8 am – 12 pm & Tues & Fri 9 am – 2 pm
Walid Harbinger, MD <----------------------------------------
Walid Sousan, MD
Iman Ghaddar, MD
mesa177 wrotekareem_nasser wrote:When the surgery is completed why dont they remove the flap?
The flap is part of the cornea, so it helps in the healing process.
But i saw from the video that they cut it!
They cut it but not in a full circle . they leave a small portion uncut and flip the flap over that and work . the outer layer has an optical function as well. The flap also needs to be placed back properly as to not cause damage to one's vision focus. they use some liquid that aids in positioning. the flap once put back on will stay like that and not fall back off because it will be sucked back into place.

Good and lengthy write Mesa ! :)
Warning: This next post may cause distress for some people. It is about port-wine stains and hemangiomas.

Due to time restriction, I'm going to post about this topic in 2 partitions:

Part 1: Recognizing Port-wine Stains and Hemangiomas
Part 2: Treatment Methods and Favorable Machines Used
__________________________________________________________________________________________

Part 1: Recognizing Port-wine Stains and Hemangiomas


Naevus Flammeus or Port-wine Stains



What is a Port-wine Stain?

Port-wine stain or naevus flammeus (“naevus” is plural for latin word “nevus” which is a sharply-circumscribed and chronic lesion of the skin i.e. birthmark; “flammeus” is latin for flaming) is a birthmark that looks like splashed maroon-wine over the skin. They start as pink at birth, but they become darker (reddish brown or dark red) as children grow.

Where does it appear?

Port-wine stains usually appear on the face, neck, scalp, arms or legs.

How does it look and feel like?

These stains can be of any size, but they tend to grow in proportion with a child. At first, it is smooth and flat, and the texture changes with growth. They become thicker and can feel like pebbles under the skin during adulthood.

Why do port-wine stains appear?

When an area of the skin doesn’t get a sufficient (or any) amount of nerve fibers (fibers that help keep the smallest blood vessels, known as capillaries, narrow), the capillaries keep expanding. This allows more blood to flow into the blood vessels, hence causing stains to form under the skin. These port-wine stains develop into birthmarks known as vascular birthmarks.

They cannot be prevented from occurring, and, unlike some beliefs, they are not caused by anything a mother did done during her pregnancy.

How can port-wine stains be diagnosed? Can it be confused with other birthmarks? What forms require treatment?

A dermatologist should be consulted when a port-wine stain is viewed since they can be confused with other forms of vascular birthmarks.

Macular stains (also known as salmon patches, angel kisses, or stork bites) can sometimes highly resemble port-wine stains. They are faint red marks that are often found on the forehead, eyelids, back of the neck, back of the head, nose, or upper lip. They look like this:



These stains fade by their own when a child becomes 1 or 2 years old.

Both port-wine stains and macular stains are harmless birthmarks and in most cases are mild, so they do not require treatment. However, they can be treated through laser therapies such as Pulsed Dye Laser or PDL.

Port-wine stains can also be confused with hemangiomas (heads up xterm). Hemangiomas (“haema” is greek for blood, “angio” is derived from new latin / greek word “angeio” that means vessel, and “oma” is greek for tumor) is a benign (kind) self-involuting (self-shrinking) tumor of endothelial cells (note: recognized as tumor because it involves the swelling of endothelial cells, the cells that line blood vessels). It is the most common form of tumor at infancy, and they grow rapidly during an infant’s first 6 months or so. On the other hand, it usually shrinks back and disappears at around ages 5 to 10 years. Hemangiomas are commonly found on the head or neck, and they exist in two forms: superficial (or strawberry) hemangiomas which are bright red, raised birthmarks like the one shown here:



Or deep hemangiomas which are bluish-red, puffier birthmarks like so:



Hemangiomas can also come as a mixed form of superficial and deep hemangiomas. Deep and mixed hemangiomas usually drive a doctor to order a CT or MRI scan to rule out rare medical conditions (more about this in the next section). While superficial hemangiomas are often not treated (since they disappear on their own), they can be treated with laser (PDL, some say it’s effective but a study showed the complications so it’s is highly not recommended ; an alternative known as flash-lamp pumped pulsed dye laser or FPDL is better; more on this in the next section). Deep and mixed hemangiomas that grow near or on eyelids block a child’s vision; thus, they are treated with either steroid injections or laser treatment (PDL but quite effective; usually they are surgically removed; more on this issue in the next section).

Are port-wine stains and hemangiomas dangerous?

It depends on the location of both the port-wine stain and hemangioma (for the latter case, the type also affects the degree of risk on the child’s health).

For port-wine stains, those located on or near the eye and on the forehead need to be monitored. Though extremely rare, they can be an indication of a more severe medical condition: a sort of “stain on the brain” uncommon neurological disorder called Sturge-Weber Syndrome which can cause seizures, developmental delays, and learning disabilities; or Klippel-Trenauny Syndrome which is another rare disease that is characterized by not only the appearance of port-wine stains but also other vascular anomalies like varicose veins and/or too much bone and soft tissue growth. When port-wine stains start to appear on the eyelids, they can lead to glaucoma (very rare though; this is usually associated with hemangiomas), an eye disease that causes increased pressure in the eyes which can affect vision and lead to blindness if left untreated.

Hemangiomas are a bit of a more serious case: they can break down on a surface causing ulceration and/or bleeding (especially when injured). If located near the mouth or nose (or even the larynx aka voice box), they can cause problems with breathing and eating. If located near the eye, they can cause vision problems (amblyopia or lazy eye, or strabismus or crossed eyes) and glaucoma. Hemangiomas can also contract secondary infections and sores.

It’s all about the location of these hemangiomas, and extra attention should be given to deep ones. Hemangiomas that endanger an important bodily function (vision) or are life-threatening (obstruction of airway) require immediate intervention. Also, ones that are located in certain anatomic locations like nose, lip, ear, hands, feet and face should be treated because they can leave permanent scars or deformities that lead to psychological problems especially when the child begins school. Extra attention should be given for ulcerated hemangiomas and ones located in urogenital regions. Some hemangiomas cause associated malformations, e.g., PHACES syndrome (Posterior fossa malformations, Hemangiomas of the cervicofacial region, Arterial anomalies, Cardiac anomalies, Eye anomalies and Sternal or abdominal clefting or ectopia cordis).

In like two days, part 2 will be posted. I'll also post my references and some pamphlets.
That's very nice Mesa, thank you.

I've already done extensive research on this subject for over 5 months (second day after my son was born), I wish this article had been available then because i had to dig a whole lot to consolidate that exact information that you posted.

I've consulted with several pediatricians, dermatologists even ENT doctors, i wasn't willing to risk anything if it affected my son's health. I've even contacted renown doctors in USA, France and Switzerland, doctors whose sole specialization is vascular malformations.

I got zilch response from the lebanese doctors, they are seriously lacking in terms of progress in this area. All the international doctors requested that i monitor closely the progress of the vascular malformation, their diagnostic was that it was either a port wine stain or an early version of hemangioma. After 5 months, i now safely identify the birthmark as a Port Wine Stain (a.k.a Surface Angioma). The problem is, that i cannot, for the life of me, find someone who can give me a direct answer on how or when i can proceed with PDL treatment.

I want to make a quick note is that a couple of years back, their was a rather huge discovery, wherein Hemangiomas can be treated with PROPANOLOL (which honestly freaked the shit out of me).

Anywho, I'm anxiously awaiting your second post. I'd also like to suggest, given the interest in this topic, by most, to split this topic into several topics.

Laser Based Surgeries, being this topic, with links to other topics for every laser surgery type.

Again, thanks alot.

Edit: Below is a picture of the birthmark at the 1 month mark, it remains the same today.

JAD!

THANK YOU!

Edit: Here's the little devil, soon to be minigeek, at age 5.5 months
Jad, you hit the right spot :) I was actually going to suggest Dr. Touma when my dermatologist lead me to his website just about 5 minutes ago. There's also the Clemanceau Medical Center which has a great dermatology department. Since the CMC is for high-class people, I'm betting that their treatment sessions cost way more than going to Dr. Touma. Let me dig a little bit more and get back to you. PS: Raul is uber cuuuute :)
Things get better and better, I just got a message froma friend biomedical engineer at AUH, and he told me they have "laser treatment for port-wine stains". Contact: 01-350000, Dermatology department - Ext: 5337. I'll try to squeeze some info about the machine used.
I don't really like ophthalmology, I'd rather study "Plastic Surgery"
6 years left until I get to chose :P
mesa177 wroteThings get better and better, I just got a message froma friend biomedical engineer at AUH, and he told me they have "laser treatment for port-wine stains". Contact: 01-350000, Dermatology department - Ext: 5337. I'll try to squeeze some info about the machine used.
Thaaaaaaaaaaank youuuuuuuu!

Edit: Seems like AUH stopped using PDL they're using something called Cultura or cultra or cutra?
@xterm: Cultura Medical Spa, it's a combination of laser therapy (PDL) and steroid medication. Details later on. I'll email my friend to send in details as well.
!! I'm so not bringing steroids in any way close to my child.

I'll wait for details.
Woops, my bad, I thought it's steroids, turns out it's only a sclerosing solution (Nicholas should have been clearer about it). It's a solution used to thicken the walls of the capillaries by irating their walls causing them to stick together. More info here. They also use IPL (which is a big surprise to me, but when I read it, it kind of made sense) to treat facial capillaries. The steroids are used for scar treatment.

Right now I'm busy with a research for work, so I'll try posting part 2 soon.

PS: I found out there's a center called "Beirut Lasik Center" across the Qwaity Embassy. This is some info from Linkedin:
Dr. Samer Mneimneh operates at “ Beirut Lasik Center, Lebanon ” where you can enjoy hospitality, the best security and the safest accuracy for providing the best results in laser treatment nowadays. This again improves the quality of YOUR result.
Dr. Mneimneh has been doing refractive surgery since 1993, providing attentive care for patients seeking the most appropriate eye care available. This experience serves to put YOUR mind at rest
Specialties
Lasik eye surgery in Beirut Lebanon
Also this is the profile of the surgeon as written on Linkedin. God knows if it's true, so I'll try finding more about it.
My friend Nicholas gave me the name of the technician to talk to at AUH, so I called him today and inquired more about the treatment of port-wine stains. As I progress in my discussion, I ask him whether steroids or sclerosing solutions are used. He answers no, so I say: but isn't that part of the Cultura medical spa treatment? He tells me you must have heard wrong (though I clearly read it in my email, I could almost kill my friend), they use the Cutera Excel V laser. I asked if the machine can be used to treat infants and young children (age 6 months for example), and he says yes because the laser type and dose are adjusted according to nature of skin or vein treatment (removing scar tissue, port-wine stains, varicose veins...) and age range.

There are two types of lasers to select from (the dermatologist's responsibility):

1- KTP laser: a beam generated by a neodymium:YAG i.e. Nd:YAG laser is directed through a potassium titanyl phosphate crystal to produce a beam in the green visible spectrum; used for photoablation and photocoagulation. The Cutera has a mode that dispenses 532 nm KTP laser beams.

2- neodymium:yttrium-aluminum-garnet (Nd:YAG) laser: a laser whose active medium is a crystal of yttrium, aluminum, and garnet doped with neodymium ions, and whose beam is in the near infrared spectrum at 1060 nm; used for photocoagulation and photoablation. The Cutera has 2 modes that are capable of dispensing Nd:YAG laser beams up to 1064 nm.

=> In layman terms, the type of laser is selected according to the nature of the therapy involved (lower wavelength = higher frequency = higher intensity of radiation).

So, after doing my research about it, I find that this kind of laser treatment is actually better than the PDL (the Nd:YAG based laser does the job of a sclerosing solution and PDL laser simultaneously, and it has a more advanced cooling system to relief pain => better pain management than PDL which does cooling but on the longer run in the session, PDL machines like the Candela-V beam start to heat up at a faster rate than the Cutera Excel V). A more detailed explanation will be provided later when I finish writing the article. For now, I recognize the Cutera laser treatment better than PDL. No wonder why they traded PDL for Cutera at AUH... Smart dermatologists I guess :)