The center has a state-of-the-art and complete technical platform for the diagnosis and monitoring of most eye pathologies.
This is the first technique using the Excimer Laser for the treatment of vision defects.
This surgical technique involves three operating steps:
1- Mechanical peeling of the corneal epithelium, with a brush or scarifier, with or without diluted alcohol.
2- Application of the laser beam, computer-assisted, on the cornea underlying the epithelium.
3- Application of mitomycin diluted 0.02% in case of deep ablation to avoid subepithelial scarring (Haze).
The abrasion of the superficial cells of the cornea causes postoperative pain for a few days requiring treatment with painkillers.
Visual recovery is slow; one to two weeks.
This technique is reserved for medium degrees of vision defects: myopia, hyperopia, astigmatism.
Both eyes are operated separately, or simultaneously.
The Excimer Laser is used in various refractive surgery techniques.

Technique specific to the Schwind Amaris Excimer laser:
- Abrasion of surface epithelial cells by the laser
- Followed by collagen abrasion by the same Excimer laser.
The advantages of this technique are:
- Speed: processing in a few seconds
- Proximity of epithelial ablation and collagen ablation favoring faster healing and reduction of the postoperative painful period
- This technique avoids mechanical ablation and the use of diluted alcohol on the epithelium.
- This is the only surgical technique without any contact with the cornea, the laser itself doing all the steps of the surgery.

TransPRK:
The only treatment by which, without contact with the eye, and in a more precise way than before, the epithelium is ablated by the excimer laser and then the collagen is ablated for the correction of refractive ametropia.
TransPRK – “No contact” treatment:
The ablation of the epithelium and the refractive anomaly are carried out immediately one after the other. As a result, the total time of the intervention is significantly reduced.

The Excimer Laser is used in different refractive surgery techniques

This is the technique most frequently used by refractive surgeons in the United States and Europe. Available in our center located in Brussels (Belgium):
- Lasik or Laser In Situ Keratomileusis begins with the production of a thin superficial corneal lamella (hood).
- This flap is produced using an automated microkeratome or a Femtosecond laser.
- It is then lifted and remains attached to part of the corneal periphery
- The computer-assisted Excimer laser beam is applied to the underlying part.
The flap is then repositioned, without sutures. Adherence occurs spontaneously within a few days.
The postoperative course is painless and visual recovery is rapid, in a few hours, because no abrasion is made on the surface of the eye.
Lasik is aimed at medium and strong degrees of vision defects: myopia, hyperopia, astigmatism.
Since 2007, he has been treating presbyopia associated with myopia, hyperopia and astigmatism using the Optimized Global Monovision technique, which promotes a better accommodation margin for near vision.
Since 2008, Doctor Assaf has also been performing corneal flaps using the Femtosecond LDV laser: corneas that are too arched or too flat, corneas that are too thin, etc.
He also uses the latest software to treat corneas by refractive surgery while preserving a natural prolate shape of the cornea, optimizing visual quality (Eye Q).
Since 2013, Doctor Assaf has been using the Lasik micromonovision technique with the Schwind Amaris laser for the treatment of presbyopia associated with myopia, hyperopia and astigmatism.

The Excimer Laser is used in different refractive surgery techniques

Like our fingerprints, our eyes have an individual shape with their own characteristics. The personalized treatment by aberrometry uses software allowing the treatment of optical aberrations specific to each eye.
Its objective is to improve visual quality compared to glasses, contact lenses or conventional treatment.
Until 2002, electronic diagnostic devices could detect myopia, hyperopia and astigmatism. These optical defects account for approximately 90% of total eye abnormalities. The remaining 10% are called higher order optical aberrations.
Thanks to new devices called aberrometers, we can currently measure and treat these higher-order aberrations, in a personalized way, with respect to each patient.

Analysis by Wave Front:
It is a technique originally developed by astrophysicists and which is currently applied for the treatment of refractive errors.
The analysis of the reflection image through an optical grid makes it possible to analyze the optical aberrations characteristic of each patient.
- This analysis is done without contact with the eye by simply taking photos, which allow the analysis of the entire optical system of the eye, from the retina to the cornea.
- The measurement of aberrations is combined with the analysis of the anterior and posterior corneal topography, by a topographic map (Orbscan).
- The parameters measured by the Aberrometer and the Orbscan, are combined on a diskette which allows computer-assisted treatment of conventional anomalies (myopia, astigmatism) and higher order optical aberrations, during a PRK procedure, or LASIK.
The advantages of a personalized treatment by Aberrometry and Topoguided Corneal Wavefront are as follows:
- Personalized treatment according to the aberrations of each eye.
- Improvement of the best postoperative visual acuity, sometimes going to a view greater than 10/10.
- Improved night and sometimes daytime visual quality.
- Lower risk of reduction in best corrected visual acuity.
- Better stability and reduced risk of reprocessing.
- Possibility of treatment of severe ametropia not treatable until now by the conventional technique, although associated with a cornea of ​​average thickness, or associated with a large pupillary diameter in the penumbra.
- Possibility of correction by reprocessing of patients previously operated by refractive surgery presenting irregular astigmatism, a small optical zone… resulting in nocturnal visual disturbances: Halos, dazzling by light…
It is important to note that the treatment by aberrometry will be mainly indicated in patients who will have, according to the preoperative results, significant aberrations or a large pupillary diameter in the penumbra and a favorable profile advocating a better result than with the conventional technique.

The Excimer Laser is used in different refractive surgery techniques

Definition: this is the placement of an intraocular implant, correcting the refractive error, without removing the lens.

Indications: all refractive anomalies not operable by Excimer laser, namely:

High myopia > -10 diopters
High hypermetropia > +5 diopters
High astigmatism > 5 diopters
Cornea too thin

Types of implants

ARTISAN
ARTIFLEX
VISIAN ICL
BIOPTICS

This is the first surgical technique used for the correction of myopia.
This technique was commonly used in the 70s and 80s, before the arrival of the Excimer Laser.
It consists of making several radial corneal incisions, from the periphery to the center.
The number and length of incisions depends on the degree of myopia.
The purpose of this intervention is the flattening of the anterior cornea allowing the retraction of the focal point of the images on the retina.
The incisions are made using a pre-calibrated diamond knife.
Radial keratotomy treats low myopia and low astigmatism.

It is a myopic phakic implant (without removal of the natural lens) with a specific characteristic of being foldable.
Its introduction is carried out through a small incision of 3 mm.
Its fixation is like the Artisan Irienne.
Its advantage is to reduce the size of the incision and reduce the incidence of postoperative astigmatism.
Its disadvantage is that it predisposes to a more frequent deposit of pigments given the material used and requiring a longer anti-inflammatory treatment than the Artisan.
Visual recovery with this implant is obtained the day after the intervention.
Reversibility = the Artiflex implant is easy to remove if an exchange is necessary.
It also corrects high myopia up to -15.5 diopters.

ARTIFLEX Toric: Corrects astigmatism associated with myopia simultaneously.

Types of implants
ARTISAN
ARTIFLEX
VISIAN ICL
BIOPTICS

INDICATIONS OF THE DIFFERENT TECHNIQUES

Radial keratotomy: Myopia -1 to -3 diopters
PRK or Lasek: Myopia -1 to -3 diopters, astigmatism -1 to -3 diopters
TRANS PRK: Myopia, hypermetropia and Astigmatism from +/-1 to +/-5 diopters
Lasik and Femtolasik:
Myopia: -1 to -10 diopters
Astigmatism: +/- 1 to +/- 5 diopters
Hyperopia: + 1 to + 5 diopters
Aberrometry: Personalized treatment by Aberrometry and Ultra Thin Lasik:
Myopia: -1 to -10 diopters
Astigmatism: -1 to -6 diopters
Presence of significant optical aberrations
Large pupil diameter in the dark
Indication for improvement in visual quality
Thin cornea

Special features of all surgical techniques

KR, PRK, Lasek, Trans PRK, Lasik and Femtolasik are techniques that can lead to regression, under or over postoperative correction due to the individual variability of human corneal tissue, compared to the ablation profile.
The regression rate is 1 to 2%. A free touch-up is then necessary 2 to 3 months after the first intervention.
Retouching for over or under correction after radial keratotomy or PRK can be performed by PRK or Lasik
Alterations after (Femto)lasik will only be done by (Femto)lasik

Inclusion criteria for refractive surgery

Age: > 19 years old
Myopia, astigmatism or hypermetropia stable for more than 2 years
Absence of eye diseases: keratoconus, progressive glaucoma,
chronic herpes...
Absence of chronic autoimmune diseases and collagenoses: lupus, periarteritis nodosa, scleroderma…
Absence of poorly controlled ocular diabetes
Good motivation: professional, esthétique, sportive

Complications specific to each surgical technique:

Radial keratotomy

- Daily visual fluctuations
- Night glare and halos
- Secondary or progressive hyperopia
- Theoretical weakening of the globe

PRK–Trans PRK–Lasek

- Postoperative pain 2 to 3 days
- Delay of epithelialization
- Haze or subepithelial scarring, responsible for visual haze, gradually diminishing: 1 to 2%
- Nocturnal halos, in case of high myopia, and large pupillary diameter and in case of subepithelial scarring.
- Low risk of postoperative infection or inflammation: 1/4000

Lasik–Femtolasik

- Risk of displacement or folds of the corneal flap in the first days in the event of brutal friction or folds of the flap, hence the need to wear a rigid shell, at night, for 2 weeks after the intervention.
- Risk of dry eye requiring the instillation of artificial tears, one month after the operation.
- Risk of invasion of the space under the corneal flap by epithelial cells, requiring rinsing (0.1%).
- Risk of an inflammatory reaction under the corneal flap requiring anti-inflammatory treatment or rinsing (0.5%).
- Risk of nocturnal halos, in case of high myopia and larger pupillary diameter
- Low risk of postoperative infection or inflammation: 1/5000
- Risk of ectasia or irregular astigmatism: This is an exceptional and late complication, occurring mainly on corneas with frustrated keratoconus or other corneal pathologies not diagnosed or not apparent preoperatively. This complication occurs especially when the flaps are thick and the ablation of the corneal tissue is deep.

Aberrometer

- Personalized treatment by aberrometry, either by Lasik or PRK.
- Complications identical to the chosen technique
- Less frequency of halos and nocturnal glare.

This is a new surgical technique for myopia and astigmatism by Femto Second laser. It is performed under local anesthesia by drops.
The laser pre-cuts a small lenticule in the thickness of the cornea corresponding to the volume of myopia and astigmatism to be treated.
The laser makes a small peripheral incision (2 to 4 mm wide) through which the surgeon will dissect the lenticule and extract it from the cornea.
The results of this technique in the case of myopia and astigmatism are predictable and lead to very good refractive results.

ADVANTAGES

Absence of creation of a fragile flap in the event of friction and trauma.
- Less dryness

DISADVANTAGES

- Slower visual recovery.
- Optimal vision after a few days and not the next day like Lasik.
- Need for longer-lasting anti-inflammatory treatment.
- SMILE, unlike Lasik, does not currently treat strong astigmatism and farsightedness.
- Difficulty of reprocessing in case of over and under correction.

COMPLICATIONS

The complications are identical to refractive surgeries by Laser (infections, inflammation, night vision disorders, etc.) except for the folds and displacement of the flap.

The Excimer Laser is used in various refractive surgery techniques:

PRK
TRANSPRK
Lasek
LASIK
Femtolasik
Aberrometry and personalized treatment by wavefront
ULTRA-THIN LASIK and Sub-bowman Keratomileusis (SBKM)

The Excimer Laser whose name comes from EXCIted diMER uses the energy of the photons released by the electrical excitation of the Dimer Argon Fluor, to carry out a superficial abrasion of the cornea and correct the refractive defects: myopia, hyperopia, astigmatism.
The Excimer laser treatment is always computer assisted to define the profile of the corneal ablation according to the preparatory examination.