R E L E X S M I L E A N D S M I L E E X T R A . . O U R 1 Y E A R R E S U LT S A N D PAT I E N T S S U RV E Y

D R S A N D I P M I T R A M D F R C S C O R N E A A N D R E F R A C T I V E F E L L O W ( R O YA L V I C T O R I A E Y E A N D E A R H O S P I TA L , A U S T R A L I A )

W H Y W E S TA RT E D R E L E X S M I L E A N D W H AT WA S T H E G O A L

R E L E X S M I L E U N I T AT T H E A L Z A H R A H O S P I TA L S H A R J A H U A E

T O P R O V I D E A N A LT E R N AT I V E T O L A S I K A N D P R K

R E D U C E T H E H A Z E , PA I N A N D S L O W R E C O V E R Y O F P R K

T O R E D U C E T H E R I S K O F M A K I N G F L A P S I N L A S I K

R E D U C E D R Y E Y E S , I M P R O V E N I G H T V I S I O N , M A I N TA I N C O R N E A L S T R E N G T H

L A S I K W I T H O U T F L A P A N D P R K W I T H O U T H A Z E A N D PA I N

P R O B L E M S O F P R K

C O R N E A L H A Z E A N D U S E O F C Y T O T O X I C D R U G M I T O M Y C I N C ( W H I C H I S O F F L A B E L A N D E R R AT I C I N A C T I O N ) D O S E N O T W E L L A D J U S T E D ,

C A N L E A D T O E N D O T H E L I A L D A M A G E ( S T U D Y B Y M O H A N E T A L )

L A S I K P R O B L E M S

E P I T H E L I A L I N G R O W T H

E D G E L I F T A N D F L A P D I S P L A C E M E N TD E C E N T E R E D A B L AT I O N

P R O P E R C E N T R AT I O N I S A C H A L L E N G E A N D D E P E N D S O N

PAT I E N T S C O O P E R AT I O N

L A S I K P R O B L E M S

D R Y E Y E S B U T T O N H O L E

F O L D A N D S T R I A EN I G H T G L A R E

R E F R A C T I V E L A S E R S E T U P AT A L Z A H R A P R I VAT E

H O S P I TA L S H A R J A H

6

1.Make a special unit for relex smile procedure

2. undergo special training for the smile procedure under special team from Carl zeiss

3. Prepare a team of ophthalmic technician, trained nurse

4. patient comfort and sterility

5. keep the price competitive

6. prepared information booklets and videos for the patient

W H AT Z E I S S P R O M I S E D U S

• Minimally invasive surgery: 80% less side cut

(compared to LASIK) 30% less cap cut

• Preserves integrity of upper corneal layers

• Indicates preservation of corneal biomechanical stability

• Less nerves severed

• Indicates less varying severity of dry eye syndrome

• no flap minimizes the risk for flap complications such as

• epithelium in-growing, flap dislocation, infections

• faster healing of epithelium

W H Y R E L E X S M I L E • Spherical patient interface and unique corneal suction

• for minimum eye irritation

• Less tissue compression

• Automated vacuum system

• Shortest suction time

• Minimal IOP increase

• No vision loss during suction

• Lowest IOP increase during treatment

A D VA N TA G E S• No laser calibration or fluence test with impact on treatment result required

• No controlled airflow and plume removal necessary

• Refractive correction by femtosecond lenticule cut is

not affected by ambient room conditions

• Fully corrected optical zone from center to periphery

• Corneal topography maps post-op confirm prolate shape of optical zone

• ReLEx smile user reports showed lower induction of wavefront errors than Lasik,

• in particular for spherical aberration

E Y E T E S T W I T H T H E D O C T O R

M A P P I N G Y O U R E Y E S A N D M E A S U R I N G

T H E T H I C K N E S S O F C O R N E A

M E A S U R I N G T H E T E A R F I L M

M E A S U R I N G T H E S I Z E O F P U P I L

W H O A R E E L I G I B L E ? A G E A B O V E 1 8 Y E A R S W I T H S TA B L E R E F R A C T I O N F O R L A S T 2 Y E A R S

M Y O P I A F R O M - 0 . 5 0 T O - 1 0 D I O P T E R A N D A S T I G M AT I S M B E T W E E N - 0 . 5 0 T O - 5 D I O P T E R

N O T E L I G I B L E F O R S M I L E : P R E G N A N C Y A N D B R E A S T F E E D I N G ,

U N S TA B L E R E F R A C T I O N A N D H Y P E R O P I A

Our results for 200 eyes follow up of max 6 months

11

0

25

50

75

100

<20/40 20/30 -20/25 20/25-20/20 >20/20

S N E L L E N V I S U A L A C U I T Y U N A I D E D

Percentage of patients

95%

90%

5 %

1 week

1 month

more than 1 month

V I S U A L O U T C O M E S A R E T H E L E V E L O F A D VA N C E D L A S I K / P R K O R E V E N B E T T E R

C O N V I N C I N G S TA B I L I T Y W I T H A L M O S T N O R E G R E S S I O N O V E R T I M E

200 eyes reached 20/20 vision after 1 week

None of the eyes had any regression after

6 months of follow up

E X C E L L E N T P R E D I C TA B L I T Y, R E S U LT S V E R Y C L O S E T O TA R G E T R E F R A C T I O N , E V E N F O R H I G H M Y O P I C C O R R E C T I O N S

R E F R A C T I V E O U T C O M E S W I T H I N ± 0 . 5 D F O R 9 7 % O F E Y E S

*

31%

27%

31%

8%2%-10 to -8 D

>-8 to -6 D

>- 6 to -4 D

>-4 to -2 D

>-2 to 0 D

PRE OPERATIVE EFRACTIVE ERROR DISTRIBUTION

0

10

20

30

40

-10 to -8 <-8 to -6 <-6 to -4 <-4 to -2 < -2 to 0

POST OPERATIVE REFRACTIVE ERROR DISTRIBUTION

<0.25 to -0.25 D

>-0.25 to -0.50 D

>-0.50 to -0.75 D

>-0.75 D to - 1 D

> -1 D

MAJORITY OF PATIENTS WHERE BETWEEN -4 D TO -10 D

NO STATISTICALLY SIGNIFICANT DIFFERENCE

IN THE POST OPERATIVE CORRECTION IN SMALLER REFRACTIVE ERROR COMPARED TO THE THE LARGER

REFRACTIVE ERROR

Excellent predictablity, results very close to target refraction, even for high myopic corrections  Almost 100 % of all patients achieved target refraction within the typical „satisfaction zone“ (± 1.0 D), 97% with a precision of ± 0.5 D.

PAT I E N T S S U R V E Y O F P O S T O P E R AT I V E G L A R E A N D N I G H T V I S I O N A F T E R R E L E X S M I L E

P R O B L E M S I N N I G H T V I S I O N

A F T E R T H E S U R G E RY

1%4%

95%

no glare mild glare

moderate glare severe glare

N I G H T V I S I O N S AT I S FA C T I O N

• excellent night vision in 99% of patients

• Pupil size varied from 5mm till 7 mm

• 1 patient developed glare which disappeared after 1 month, (wavefront optimised treatment)

• average Lenticule size 6.7 5mm, which was more than the size of the scotopic pupil in 99% of cases

PA I N S C O R E D U R I N G T H E P R O C E D U R E

8%5%

87%

no pain mild pain moderate pain

severe pain very sever pain worst possible pain

Post Smile Dry eye score from our patient based on number of Artelec Adv minims used after

1 week post operatively

3%8%

20%

20%

50%

using no drops once a day twice a day thrice a day

more than 4 times

E F F E C T O N D R Y E Y E S

• 99 % of patients did not complain any dry eye problems after the Smile procedure

• Average use of eye lubricants was from 2 weeks

• no need for any ointment in any patients

• Early return of corneal sensation after 1 week after the procedure

B A S E D O N E X P E R I E N C E W O U L D Y O U R E C O M M E N D S I M I L A R T R E AT M E N T T O

Y O U R FA M I LY A N D F R I E N D S

yes with great pleasure 90 %

yes with pleasure 5 %

yes 5%

no 0%

R E L E X S M I L E P L U S C O L L A G E N C R O S S L I N K A G E

20

+49 3641 220 - 007745 Jena, GermanyGöschwitzer Str. 51-52

Time:

Treatment date:

Physician:

Date of birth:

Pat. ID:

sneade, adamName:

Axis [°]:Cylinder [D]:Sphere [D]:

Manifest

Pachymetry [µm]:Mean K-reading [D]:Corneal radius [mm]:

Cornea vertex distance [mm]:

Side cut angle [°]:Max:Min:Thickness [µm]:

Transition zone [mm]:Optical zone [mm]:

Lenticule data

Incision width [mm]:Incision angle [°]:Incision position [°]:Side cut angle [°]:Thickness [µm]:Diameter [mm]:

Cap data

Axis [°]:Cylinder [D]:Sphere [D]:

Refractive correction

Nomogram infoSuction time [hh:mm:ss]:Treatment pack size:

Axis [°]:Cylinder [D]:Sphere [D]:

Remaining refraction

RST [µm]:

SMILE cuts created.

Page 1 of 1

All rights reserved.Carl Zeiss Meditec AG

Copyright 2005-2011Software version 1.16

VisuMax

S M I L E E X T R A A N D R E S U LT S

• 6 eyes were treated with relex smile with collagen cross linkage

• we have used Vibex extra infusion for 8 minutes and UV exposure 30mW/cm2 for 3 minutes (Avedro platform)

• none of the patients showed any significant haze and any loss of Snellen’s visual acuity

• There was stabilisation of topography and no signs of keratinous after the treatment

C O M P L I C AT I O N S W E H AV E N O T I C E D A N D H O W W E M A N A G E D

• Two eyes had vacuum loss

• One was converted to RElex FLEX

• and one eye was treated with Femto Lasik

• One eye had poor lenticular cut which was dissected manually and had no loss of visual acuity

W H AT A R E T H E P R O B L E M S W I T H R E L E X S M I L E

! learning curve for this procedure and needs training and certification

! proper instrumentation and avoid dissection and only use blunt instrument to separate the bubble.

! Vacuum loss, loss of lenticule, under correction and overcorrection

! Retreatment can be done if enough corneal thickness is available or PRK can be done

23

QUALITY OF LIFE BEFORE AND AFTER RELEX SMILE PROCEDURE

10%0%0%4%

86%

MUCH BETTER BETTER

SLIGHTLY BETTER SLIGHTLY WORSE

SUBSTANTIALLY WORSE

O U R C O N TA C T S : T E L : 0 6 5 6 1 9 9 9 9

0 4 3 3 1 5 0 0 0 0 4 3 7 8 6 6 6 6

W W W. A L Z A H R A . C O M W W W. S A N D I P M I T R A . C O M

P R O P E R C E N T R AT I O N

T E C H N I Q U E S T O I M P R O V E Y O U R R E S U LT S

• proper head positioning and docking by placing Toric mark

• keep the area free of excess fluid, perforated speculum

• communicate with the patient during the surgery

• develop the expert mode for reducing the laser time and smother cut, proper energy and spot size

• avoid excessive dissection and use blunt instrument

• proper detection of anterior and posterior layers of the lenticule

V I D E O P R E S E N TAT I O N O F T H E S U R G E RY

P R O P E R D O C K I N G A N D M A R K E R F O R C O R R E C T I N G C Y C L O T O RT I O N

T H A N K S W W W. S A N D I P M I T R A . C O M W W W. A L Z A H R A . C O M 0 6 5 6 1 9 9 9 9 / 0 4 3 3 1 5 0 0 0 E M A I L : S A N D I P. M I T R A @ A L Z A H R A . C O M

Enjoy fashion and swim without glasses after Relex Smile