Скачать презентацию IN THE NAME OF GOD New femtolasik Refractive Скачать презентацию IN THE NAME OF GOD New femtolasik Refractive

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IN THE NAME OF GOD New femtolasik Refractive suite Mohsen Farvardin M. D. IN THE NAME OF GOD New femtolasik Refractive suite Mohsen Farvardin M. D.

Swiveling bed • • • Improved patient comfort Better ergonomic handling Faster procedures Fast Swiveling bed • • • Improved patient comfort Better ergonomic handling Faster procedures Fast swiveling motion & variable swiveling angles (30° or 45°) Adjustable headrest (height) Left/right eye detection, automated movement from OD OS and central position 3

Wave. Light® FS 200 Wave. Light® FS 200

Why femtosecond LASER? Safety Reproducibility (standard deviation microkeratome >20µm) Single use patient interface Precision Why femtosecond LASER? Safety Reproducibility (standard deviation microkeratome >20µm) Single use patient interface Precision Very homogeneous flap thickness minimal deviation in geometries (diameter, hinge, etc. ) Even stromal bed Versatility Wide adjustment range of geometries and parameters Non-mechanical Keratoplasty and intrastromal Rings Patient benefit Bladeless Better results (no astigmatism & abberation induction) 5

Advantages Femto vs. mechanical microkeratome Flap creation using Femto-Laser • Cutting geometries are designed Advantages Femto vs. mechanical microkeratome Flap creation using Femto-Laser • Cutting geometries are designed on the computer and created with LASER precision – Flap diameter very accurate – Large applanation area – Large effective ablation area for the Excimer – Hinge and orientation not depending to the suction ring and its application – Lamellar cut through out the flap (homogeneous thickness) – Surgeon can design and control (computer aided) side cut angle, flap thickness, diameter and centration – Visibility to the stroma through out the cutting procedure – Flap is after femto-LASER application not separated from the stroma – Custom Flap design 6

Lamellar flap created by the FS 200 7 Lamellar flap created by the FS 200 7

Versatility -Flaps -Standard Flaps (round) -Custom Flaps (oval) -Rings -Keratoplasty -Penetrating Keratoplasty - Anterior Versatility -Flaps -Standard Flaps (round) -Custom Flaps (oval) -Rings -Keratoplasty -Penetrating Keratoplasty - Anterior Lamellar Keratoplasty -Posterior Lamellar Keratoplasty 8

Wavelight EX 500 12 Wavelight EX 500 12

New Features • Build in online pachymeter (OLCR- Optical Low-Coherence Reflectometry) – Static and New Features • Build in online pachymeter (OLCR- Optical Low-Coherence Reflectometry) – Static and dynamic (during ablation) measurement of corneal thickness – Can be saved by soft button – Needs proper apex adjustment (distanced diodes) Traffic light system 19

New Features • Build in N 2 generator – Continuously purged beam-path; enhancing energy New Features • Build in N 2 generator – Continuously purged beam-path; enhancing energy stability – simplifying logistics and operation, reducing running cost and space requirements – Just one gas bottle Ar. F 20

New Features Enhanced beam-path and laser head design • The combination of a short New Features Enhanced beam-path and laser head design • The combination of a short beam-path and continuously (while switched on) N 2 purged optics (starting at the Laser head to the scanner output) grants for stability and efficient use of energy, while keeping the optics free of dust and ozone formation. • New Laser head design multiplying expected life time 21

New Features Advanced motorized Zoom Microscope • Stepless zoom • Programmable magnifications for: • New Features Advanced motorized Zoom Microscope • Stepless zoom • Programmable magnifications for: • Treatment • Start • Prepare 22

Illumination Ring • To move illumination ring to treatment /prepare position • Switches between Illumination Ring • To move illumination ring to treatment /prepare position • Switches between / combines: • Microscope - field Illumination • OP – field Illumination • Plume evacuator • Starts before Laser treatment • Increased working distance 250 mm • Infrared light illumination • NOTE: Energy sensor moves automatically (not visible) into the beam path for Energy Check 23

Allegretto’s proven features 24 Allegretto’s proven features 24

Wavefront Optimized - the solid Base Wavelight EX 500 uses the well known Wavefront Wavefront Optimized - the solid Base Wavelight EX 500 uses the well known Wavefront Optimized profiles 25

Wavefront Optimized - the solid Base Wave. Light: Wavefront Optimized. TM optical zone Wavefront Wavefront Optimized - the solid Base Wave. Light: Wavefront Optimized. TM optical zone Wavefront Optimized. TM treatments result in a large true aspheric optical zone and a functional transition zone. This results in better mesopic and scotopic vision. Non-wavefront optimized optical zone Non-wavefront optimized treatments create relatively narrow optical zone a wide transition zone. These profiles may cause night vision issues caused by induced higher order aberrations. 26

Wavefront Optimized – Visual Outcomes Effectiveness: UCVA (Uncorrected visual acuity) 100% 99% 93% 80% Wavefront Optimized – Visual Outcomes Effectiveness: UCVA (Uncorrected visual acuity) 100% 99% 93% 80% 60% 100% 99% 93% 76% 64% 40% 20% 0% 25% wavefront-guided 22% >= 20/12. 5 >= 20/16 >= 20/20 >= 20/40 >= 20/200 Wavefront Optimized. TM Both groups demonstrated similar performance for visual acuity. In both groups 93% of patients achieved UCVA 20/20 or better after treatment. Source: US Clinical Trials 200 Hz ALLEGRETTO WAVE® 27

Neuro. Track - preventing torsion Active Cyclotorsion Control: Never change a running system! • Neuro. Track - preventing torsion Active Cyclotorsion Control: Never change a running system! • The advanced Neuro. Track feature ensures active opto-kinetic eye-tracking to control cyclotorsion. • Neuro. Track forces the eye to stabilize the retinal image to achieve perfect vertical and horizontal orientation. 28

Neuro. Track - Cross Line Projector • Results from two international sites of 141 Neuro. Track - Cross Line Projector • Results from two international sites of 141 high astigmatism corrections. The post-operative plot diagram shows the high accuracy of treatment results. 29

All encompassing eye-tracking Video-based eye-tracker guarantees fast multidimensional active eye-tracking for better results and All encompassing eye-tracking Video-based eye-tracker guarantees fast multidimensional active eye-tracking for better results and outmost patient care. • High speed tracking 1050 Hz • Ultra fast - 2. 5 ms latency • Multi-dimensional eye-tracking • Requires no dilation; allows streamlined workflow • Works in infra-red light • Three independent angulated lightsources for redundant lightning • Compensation option for angle kappa 30

Why multidimensional ET? When patient is looking up and down the head isn’t moving, Why multidimensional ET? When patient is looking up and down the head isn’t moving, but the eye is rolling! Available at NEXT revision of Wavelight EX 500 31

Compensating for H and V rotation Displacement calculated by conventional Eye-Tracker Centre of ablation Compensating for H and V rotation Displacement calculated by conventional Eye-Tracker Centre of ablation using rotational compensation for X and Y rotation +x vertical displaceme nts horizontal displacemen ts Detected centre of pupil rotational centre of the eye ~13 mm below the cornea 1 st dimension: 2 nd dimension: 3 rd dimension: 4 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation Available at NEXT revision of Wavelight EX 500 32

Cyclotorsion the 5 th dimension Roots of Rotation errors: Patient check up is carried Cyclotorsion the 5 th dimension Roots of Rotation errors: Patient check up is carried out in sitting position, but treatment in supine arrangement - Patient might sit in a angled head-position to the examination tool - Rotation caused by patient “squeezing” against the speculum during ablation or flap creation Static cyclotorsion compensation for errors resulting from sitting to supine position or head position vertical displaceme nts horizontal displacemen ts Practicable for T-CAT with Topolyzer Vario Dynamic cyclotorsion compensation resulting from torsion movements during the treatment Available at NEXT revision of Wavelight EX 500 1 st dimension: 2 nd dimension: 3 rd dimension: 4 th dimension: 5 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation cyclotorsion 33

Z displacement the 6 th dimension vertical displaceme nts horizontal displacemen ts passive tracking Z displacement the 6 th dimension vertical displaceme nts horizontal displacemen ts passive tracking for large displacement in Z axis (laser stops triggering) and visual control (distance diodes) 1 st dimension: 2 nd dimension: 3 rd dimension: 4 th dimension: 5 th dimension: 6 th dimension: horizontal displacements vertical displacements horizontal rotation vertical rotation cyclotorsion Z displacement Available at NEXT revision of Wavelight EX 500 34

Pupil centroid shift caused by natural shift of pupil centre at a different pupil Pupil centroid shift caused by natural shift of pupil centre at a different pupil diameter (example: wavefront measured at scotopic pupil, while treatment is performed in mesopic to photopic condition) Pupil centroid change during ablation, caused by change of illumination or accommodation. Mesopic 1 st dimension: displacements 2 nd dimension: displacements 3 rd dimension: 4 th dimension: 5 th dimension: 6 th dimention: 7 th dimension horizontal vertical horizontal rotation vertical rotation cyclotorsion Z displacment Centroid shift Scotopic Static and dynamic centroid shift compensation for all errors resulting from pupil size changes Practicable with T-CAT and Topolyzer Vario 35

Automated Centering Automated, surgeon and predefined centering option • Corneal vertex centering – Obligatory Automated Centering Automated, surgeon and predefined centering option • Corneal vertex centering – Obligatory for Topography Guided – Pre-selectable for WFO and Custom Q • Pupil Centre centering for different lighting conditions (photopic, mesopic or scotopic) – Pre-selectable for WFO and Custom Q • Line of sight centering – Obligatory for Wavefront Guided ablation – Pre-selectable for WFO and Custom Q 36

Parallax Compensation Surgeon view: Compensated OPMI 300µm Laser and eye tracker superior OPMI = Parallax Compensation Surgeon view: Compensated OPMI 300µm Laser and eye tracker superior OPMI = Surgeons view inferior 37

Card Concept 38 Card Concept 38

Safety Eye-tracker 1050 Hz, 2. 5 ms and multidimensional active video based eye-tracker tracks Safety Eye-tracker 1050 Hz, 2. 5 ms and multidimensional active video based eye-tracker tracks pupils from 1. 0 up to 8. 0 mm Energy stability Steady and reliable energy stability throughout the treatment due to the closed loop energy control and the enhanced sealed beam path Wave. Light® EX 500 now includes N 2 purging of laser head optics! Automatic energy calibration before every patient Energy calibration Convenient fluence test on PMMA once a day Eye alignment Integrated and advanced Eye Tracker alignment & cross line projector with the Wave. Light® EX 500 Cyclotorsion passive cyclotorsional alignment Pulse control Every laser pulse is controlled from its source till the point where it is applied to the cornea no uncontrolled ablation possible with Thermal impact Minimized thermal impact because by thermo neutral pulse distribution Every 5 th pulse is allowed to overlap 39