Ablative Refractive Surgery 

Corneal Laser

Ablative Refractive Surgery (Corneal Laser)

These procedures use excimer or femtosecond lasers to reshape the cornea and correct refractive error.

A. First Generation: PRK (Photo-Refractive Keratectomy)

Technique: The corneal epithelium is removed, and the excimer laser is applied directly to the stroma.

Advantages:

Good for thin corneas.

No risk of flap complications (as with LASIK).

Disadvantages:

Greater postoperative pain.

Slower recovery (up to 1 week of blurred vision).

Indications:

Low to moderate myopia.

Patients with occupational risk (military, contact sports).

B. Second Generation: LASIK (Laser-Assisted In Situ Keratomileusis)

Technique: A corneal flap is created with a microkeratome or femtosecond laser, then an excimer laser is applied to the stroma.

Advantages:

Fast recovery (24-48 hours).

Less postoperative discomfort than PRK.

Disadvantages:

Risk of flap complications (dislocation, epitheliopathy).

Not recommended for thin corneas or keratoconus.

Indications:

Myopia, hyperopia, and astigmatism.

C. Third Generation: Lenticular Surgery (without Flap)

These techniques remove an intrastromal lenticule instead of surface ablation.

1. SMILE (Small Incision Lenticule Extraction)

Technique: A femtosecond laser creates a lenticule that is extracted through a small incision (no flap).

Advantages:

Less dry eye than LASIK.

Safer for thin corneas.

Disadvantages:

Does not treat hyperopia (only myopia and astigmatism).

More expensive technology.

2. SmartSight (Technique similar to SMILE, but with greater customization)

Technique: Similar to SMILE, but with advanced algorithms for greater precision.

Advantages:

Greater preservation of corneal biomechanics.

Option for irregular corneas.