{"id":57673,"date":"2019-01-31T14:21:43","date_gmt":"2019-01-31T14:21:43","guid":{"rendered":"https:\/\/www.humanitas.net\/?post_type=disease&#038;p=57673"},"modified":"2019-01-31T14:21:43","modified_gmt":"2019-01-31T14:21:43","slug":"chirurgie-refractive-au-laser-excimere-2","status":"publish","type":"disease","link":"https:\/\/www.humanitas.net\/fr\/diseases\/chirurgie-refractive-au-laser-excimere-2\/","title":{"rendered":"Chirurgie r\u00e9fractive au laser excim\u00e8re"},"content":{"rendered":"<h2>Technique<\/h2>\n<p>Le laser excimer peut corriger les d\u00e9fauts de vision en vaporisant le tissu corn\u00e9en froid de mani\u00e8re cibl\u00e9e. Ceci est r\u00e9alis\u00e9 sur la surface avec diff\u00e9rentes m\u00e9thodes qui ne diff\u00e8rent l&#8217;une de l&#8217;autre que dans la pr\u00e9paration pr\u00e9alable \u00e0 l&#8217;action du laser :<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>PRK : d\u00e9riv\u00e9 en anglais de &#8216;Photo Refractive Keratectomy&#8217; , qui en fran\u00e7ais signifie k\u00e9ratectomie photo r\u00e9fractive. Cette intervention chirurgicale consiste en l&#8217;ablation m\u00e9canique d&#8217;une partie de la fine surface de la membrane de la corn\u00e9e (\u00e9pith\u00e9lium) \u00e0 l&#8217;aide d&#8217;un instrument \u00e9mouss\u00e9, puis en l&#8217;application du laser excimer. Une variante plus avanc\u00e9e de cette technique est la PRK transepith\u00e9liale ; dans ce cas, l&#8217;\u00e9pith\u00e9lium est \u00f4t\u00e9 directement au moyen du laser excimer permettant la personnalisation de l&#8217;intervention directement sur la surface de la corn\u00e9e sans avoir \u00e0 effectuer de coupes ou autres man\u0153uvres chirurgicales invasives.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>LASEK &#8211; &#8216;Laser Epithelial Keratomileusis&#8217; : cette technique consiste \u00e0 soulever l&#8217;\u00e9pith\u00e9lium corn\u00e9en. Ce soul\u00e8vement est obtenu par trempage de l&#8217;\u00e9pith\u00e9lium dans une solution alcoolique. Apr\u00e8s le soul\u00e8vement, l&#8217;\u00e9pith\u00e9lium est repositionn\u00e9 sur le stroma corn\u00e9en.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>EpiLASIK : &#8216;epithelial Laser In Situ Keratomileusis&#8217;. Cette technique est \u00e9galement utilis\u00e9e pour soulever l&#8217;\u00e9pith\u00e9lium corn\u00e9en, mais contrairement au LASEK, le soul\u00e8vement est obtenu par l&#8217;application d&#8217;un instrument m\u00e9canique sp\u00e9cifiquement con\u00e7u pour soulever l&#8217;\u00e9pith\u00e9lium, appel\u00e9 \u00e9pikeratoconus. Apr\u00e8s le soul\u00e8vement, l&#8217;\u00e9pith\u00e9lium est repositionn\u00e9 sur le stroma corn\u00e9en.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Techniques chirurgicales intrastromales : le traitement au laser excimer dans ce cas ne se fait pas \u00e0 la surface de la corn\u00e9e, mais \u00e0 l&#8217;int\u00e9rieur de la corn\u00e9e, sp\u00e9cifiquement sur la couche interm\u00e9diaire appel\u00e9e stroma.<\/li>\n<\/ul>\n<p>Pour r\u00e9ussir cette intervention, il est important d&#8217;avoir suffisamment de pratique et d&#8217;exp\u00e9rience avec des instruments chirurgicaux tels que le laser excimer. La technique intrastromale consiste \u00e0 soulever le volet du tissu corn\u00e9en et \u00e0 appliquer le laser excimer afin de repositionner le volet. Dans de rares cas, il peut \u00eatre n\u00e9cessaire de placer quelques points de suture temporaires. Dans d&#8217;autres cas, le chirurgien peut d\u00e9terminer que le lambeau qui doit \u00eatre coup\u00e9 est qualitativement inad\u00e9quat. Lorsque cette complication survient, le chirurgien peut d\u00e9cider de refixer le lambeau et de retarder l&#8217;intervention \u00e0 un moment plus appropri\u00e9 dans l&#8217;avenir.<\/p>\n<p>&nbsp;<\/p>\n<p>La m\u00eame m\u00e9thode peut \u00eatre r\u00e9alis\u00e9e en profondeur, apr\u00e8s avoir coup\u00e9 et soulev\u00e9 une couche superficielle de la corn\u00e9e. Cette technique est appel\u00e9e LASIK intrastromal.<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>LASIK : d\u00e9riv\u00e9 de &#8216;Laser Intrastromal Keratomileusis&#8217;, qui en fran\u00e7ais signifie Laser cheratomilesusi interstromal. Le stroma est d\u00e9coup\u00e9 \u00e0 l&#8217;aide d&#8217;un &#8216;microplaneur&#8217; appel\u00e9 microk\u00e9ratome.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Aujourd&#8217;hui, la cr\u00e9ation d&#8217;un volet (ou &#8220;flap&#8221;) peut \u00eatre r\u00e9alis\u00e9e avec un nouveau type de laser, appel\u00e9 laser femtoseconde, qui a am\u00e9lior\u00e9 la s\u00e9curit\u00e9 et la reproductibilit\u00e9 de l&#8217;intervention en r\u00e9duisant le risque potentiel de complications.<\/p>\n<p>&nbsp;<\/p>\n<p>Les chirurgiens du service de r\u00e9fraction du Centre d&#8217;ophtalmologie Humanitas sont des professionnels qui sont \u00e0 jour sur toutes sortes de techniques chirurgicales, qui poss\u00e8dent une exp\u00e9rience chirurgicale consid\u00e9rable et qui sont aptes \u00e0 fournir les mesures et param\u00e8tres sp\u00e9cifiques qui se rapportent \u00e0 la nature des interventions qui s&#8217;av\u00e8re \u00eatre la plus favorable pour le handicap du patient.<\/p>\n","protected":false},"author":11,"featured_media":0,"template":"","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v19.7.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Chirurgie r\u00e9fractive au laser excim\u00e8re - Humanitas.net<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.humanitas.net\/fr\/diseases\/chirurgie-refractive-au-laser-excimere-2\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chirurgie r\u00e9fractive au laser excim\u00e8re - Humanitas.net\" \/>\n<meta property=\"og:description\" content=\"Technique Le laser excimer peut corriger les d\u00e9fauts de vision en vaporisant le tissu corn\u00e9en froid de mani\u00e8re cibl\u00e9e. 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