
photorifractive keratectomy

photorefractive keratectomy (prk), lazer assisted sub-epithelial keratectomy (allengil lazer epithelial keratomilyoosis) (lassec) enniva oru vyakthiyude kazhcha sariyaakkaan uddeshichulla lazer netra sasthrakriya nadapadikramangalaanu, ithu glassukaleyo kondaakt lensukaleyo aashrayikkunnath kuraykkunnu. corneal eppitheeliyathinu thottuthaazhe kanninte munvashathulla corneal stromayil ninnu cheria alavil tissue neekkam cheiyunnathinaayi (baashpeekaranatthiloode neekkam cheiyunnathinaayi) oru excimer lazer upayogichu lassec prk munbhaagathe central corneyayude aakruthi sthiramaayi maattunnu. ableshanu munbu corneyayude puram paali neekkam cheiyunnu.
upayogikkunna laserinte savisheshathakale aashrayich oru computer sisttam secondil 60 muthal 4,000 thavana vare rogiyude kanninte sthaanam tracucheyyunnu. krithyamaaya lazer placementinaayi computer sisttam lazer pulsukal redirect cheiyunnu. mikka aadhunika laserukalum rogiyude vishwal aaksisil yaanthrikamaayi kendreekarikkukayum kannu paridikk purathu neengukayaanengil thaalkkaalikamaayi nirthukayum rogiyude kannu veendum kendreekrithamaayathinu sesham aaa samayat abletting punararambhikkukayum cheyyum.
corneyayude puram paali allengil epithelium, kanneer filimumaayi sanbarkkam pulartthunna mriduvaayathum athivegam valarunnathumaya oru paaliyaan, athu vyakthatha nashtappedaathe kurachu divasathinullil limbal stem cellukalil ninnu poornnamaayum svayam maattisthaapikkaan kazhiyum. puram eppitheeliyathinu vipareethamaayi corneyayude aazhathilulla paalikal jeevithathinte thudakkathil thanne sthaapikkappedukayum punarulpadana sheshi valare parimithavumaanu. aazhathilulla paalikal, oru lazer upayogichu punarroopakalppana cheiyukayo microdome upayogichu murikkukayo cheythaal, parimithamaaya rogashanthiyo punarnirmmaanamo maathram cheythaal sthiramaayi angane thanne thudarum.
prakk upayogichu, cornia epithelium neekkam cheyyukayum upekshikkukayum cheiyunnu, ithu shasthrakriyaykk sesham koshangale punarujjeevippikkaan anuvadikkunnu. corneyayude aazhathilulla paalikalil sthiramaaya flap srishtikkunna lazer aii sarjariyude oru roopamaaya laasikkil (lazer assisted inn-sittu keratomilyoosis) ninnu eee prakriya vyathyasthamaan.
lasek.
lasek prk rund vyathyastha nadapadikramangalaanu. rund nadapadikramangalum corniaykku mukalilulla eppitheeliyavumaayi edapazhakumbol, prk nadapadikramam ithu poornnamaayum neekkam cheiyunnu, athesamayam lazer shasthrakriyaykk sesham rogashaanthikkaayi thirike vaykkunnathinu munbu lussec nadapadikramatthinaayi metteeriyal brush cheiyunnu. aastigmattisam, sameepadrishti, dooradarshithvam enniva chikilsikkaan eee nadapadikramam upayogikkaam. nadapadikramatthinidayil, nerppicha alcohol layani upayogichu epithelium sthaanabhrashtamaakkunnu.
shasthrakriyaykkide srishtikkappedunna flaappumaayi bandhapetta kooduthal sankeernathakal ozhivakkunnathinaal laasikkinekkaal gunangal piaarkinund. shasthrakriyaykk sesham varanda kannu lakshanagal undakanulla saadhyathayum eee prakriya kurachekkaam. pii. aarr. keey. nadapadikramatthinu sasthrakriya flap aavasyamillaathathinaal, athlattukalkko flap avatharippicha aaghaathavumaayi bandhapetta vyakthikalkko lassekinu gunangal kaanaan kazhiyum. kondaakt lensukal dharikkunna rogikal saadhaaranayaayi nadapadikramatthinu munbu oru nischitha samayathekku iva darikkunnath nirthendathundu.
laasikkil ninnu vyathyasthamayi kaazhchaykk kooduthal veendedukkal samayam ulppedunnathaanu pii. aarr. keey. poraaymakal. mattoru poraayma, rogikk lassic prakriyayekkaal kurachu aazhchakal kooduthal steroid aii dropukal prayogikkendivannekkam ennathaanu. prakk prakriyaykku sheshamulla kaazhchaykk laasikkinekkaal kooduthal samayam veendedukkaam, ithu mangiya kazhcha shariyaayi maaykkaan anchu divasathinum randaazhchaykkum idayilaakaam.
lassechine laasikkumaayi thaarathamyappeduthumbol, corneal moodalmanju kondu lassicinu mikacha phalangal labikkum, athesamayam laasikkinekkaal kuranja flap sankeernathakal lasekkinundu.
yogyatha.
oru vyakthi thripthippeduthenda niravadhi adisthaana maanadandangalundu
chikitsa sankeernamaakkukayo thadayukayo cheiyunna chila munkootty nilanilkkunna avasthakalum undu.
saadhyamaaya sankeernathakal.
thaalkkaalikamo sthiramo aayirikkavunna chila sankeernathakalil iva ulppedunnu
varanda annukal.
mattu tharatthilulla refractive shasthrakriyakaleppole, 'dry aii' ennu vilikkappedunna keraattokanjanktivittivitt sikka, prkyude ettavum saadhaaranamaaya sankeernathayaanu, ithu sthiramaayirikkaam. kooduthal vipulamaaya kesukalil, urakkathinidayil corneal epithelium pinthudarunnathu muthal kanninte druthagathiyilulla chalanathode mukalile kanpola vare aavarthichulla mannolipp sambhavikkunnu. shasthrakriyaykk munbum sheshavum uyarnna omega-3 ulladakkam ulla anubandha polyunsaturated phaatti aasidukal (pufas) sikki mechappeduthunnu, orupakshe avayude virudha bahyaavishkaara phalangal kaaranam. pufa adangiya bhakshanangalil chana ennayum malsya ennayum ulppedunnu. alcohol adhishtitha saankethikavidyakalkku pakaram epithelium illaathaakkaan brush prakk cheiyunnathu shasthrakriyaykk sesham alavil kuranja kannu varalchaykku kaaranamaakunnu. brush saankethikavidya upayogichu shasthrakriyaykk sheshamulla corneal hasinginte alavum kuraykkunnu. platelet activating factor lau-0901 mouse modalukalile varanda kannine laghookarikkunnathil swaadheenam kaanichittundu. docosahexenoic aasidumaayi (dha) samyojippichu topical naadi valarchaa ghadakam (engf) upayogichu muyal modalukal mechappettittund. mitomycin sii shasthrakriyaykk sheshamulla varanda kannine vashalaakkunnu.
nadapadikramatthinte phalangal vilayiruthunnathinum rogashanti prakriyayil mathiyaya kazhcha urappakkunnathinum oru samayat oru kannil pii. aarr. keey nadatthaam. nalla binocular kazhcha aavasyamulla pravartthanangal shasthrakriyakalkkum chilappol neenda rogashanti kaalayalavinum idayil nirtthivaykkendivanne.
halos, staarbarsts, refractive pishakukal.
rogashanti prakriyayil shasthrakriyaykk sheshamulla corneal moodalmanjinoppam sambhavikkaavunna glair, halos, staarbarst vyathiyanangalumaayi prk bandhappettirikkunnu. cheria ableshan soonn valuppamulla punaravalokanangalilaanu ratri halos kooduthalaayi kaanappedunnath. lazer saankethikavidyayile sameepakaala sambhavavikasangal kaaranam, 6 maasathinu sesham ithu saadhaaranamallengilum chila kesukalil lakshanagal oru varshathiladhikam thudaraam. chemotherapic ejantaaya mitomycin-sii yude nerppicha saandrata, mangiya apakadasaadhyatha kuraykkunnathinu sasthrakriya poortthiyaakumbol hrasvamaayi prayogikkaam, ennirunnaalum sikkayude apakadasaadhyatha vardhikkunnu.
rogashaanthikk sesham falamaayundaakunna refractive thiruthalinte pravachanaatheetha poornnamaayum krithyamalla, prathyekichu kooduthal kadinamaaya myopia ullavarkku. ithu refractive pishakinte kuravu/amithamaya thiruthalilekku nayichekkaam. amithamaya thiruthalinte kaaryatthil, presbiopiayude akaala prathyaaghaathangal oru saadhyathayund. parichayasambannaraaya shasthrakriya vidagdhar avarude phalangalil pravachanaatheetha kooduthal vardhippikkunnathinu oru ishtaanusritha-profile algoritam upayogikkunnu.
1 muthal 3 sathamaanam vare kesukalil, manyamaaya ablative sonukalo mattu sasthrakriya sankeernathakalo kaaranam mikacha thiruthiya vishwal akvitti (bii. sii. vii. eiii) nashtappedaam. pii. aarr. keey. nashtam undaakkunnathinekkaal eratti thavana mechappetta bii. sii. vii. aykku kaaranamaakunnu. noothanamaaya kannu kendreekaranavum tracking reethikalum upayogikkunna kooduthal aadhunika lesarukalullathinaal manyatha oru prashnamaayi maarukayaan.
laasikkumaayi thaarathamyam cheyyuka.
prakk, lassic ennivaye thaarathamyam cheytha oru chittayaya avalokanam lassicinu rogamukthi samayam kuravaanennum vedana kuravaanennum nigamanam cheythu. oru varshathinusesham rund saankethikavidyakalkkum samanamaaya falangalundu.
kuranjathum mithamayathumaaya myopia ullavaril prick, lasek nadapadikramangal thaarathamyam cheyyumbol falaprapti, krithyatha, prathikoola phalangal ennivayil enthengilum vyathyaasangalundo ennu vyakthamallenn 2016 leeii oru chittayaya avalokanam kandethi. uyarnna myopia ullavaril rund nadapadikramangalum thaarathamyam cheyth pareekshanangalonnum nadathiyittillennu avalokanam prasthaavichu.
2017 leeii oru chittayaya avalokanathil vishwal akvittiyil anishchithathvam kandethi, ennaal oru padanatthil, prk sweekarikkunnavarkku refractive pishak nedaanulla saadhyatha kuravaanennum laasikkine apekshichu amithamaya thiruthal undakanulla saadhyatha kuravaanennum kandethi.
tharangal.
vedana kuraykkaan amoyil brush gyaas cooling upayogikkunnu.
shasthrakriyaykk sheshamulla moodalmanju kuraykkunnathinulla shramathil mitomycin upayogikkunnu, pakshe ithu samshayaaspadamaaya falapraapthiyaanu. deerghakaala paarshwafalangal undakaan saadhyatha anjjaathamaanu.
yuu. ezz. sainyam.
yuu. eiii. yill.ezz.eiii. prk ulla udyogaarthikalkku special fozhsu yogyatha, combatt diving yogyatha, milittari free phaal kozhsukal ennivaykku oru puthapp elavu labikkum. airbone, eyar attaalt, renchar schoolukal ennivaykku prk, lassic enniva ozhivaakkiyittund. ennirunnaalum, lassic baadhichavar prathyeka seena yogyathayil pariseelanam nedunnathinu oru sloat labhyamaanengil oru nireekshana padanatthil cheranam. sainika niyanthrana prakaram niravadhi yunaittad stetts armi special ooppareshans command (yuu. ezz. ezz. oo. sii) skoolukalkku (haalo, scooba, sere) lassic ayogyanaakkunnu/ozhivaakkaanaavilla.
yuu.ezz. sankeernathakalonnumillenga matellaa drishya maanadandangalum paalikkunnundenkil, federal eviyeshan administration prk ulla apekshakare poornnamaayum sukhappeduthukayum sthiratha kaivarikkukayum cheythaal pariganikkum. ennirunnaalum, vaanijya vimaanakkambanikalum swakaarya kambanikalum polulla thozhiludamakku refractive sarjari ayogyamaakkunna avasthayaayi kanakkaakkunna nayangal undaakaamenn pailattumaar arinjirikkanam. koodaathe, sainika vimanam paratthaan aagrahikkunna saadhaaranakkaar thiruthal sasthrakriya nadathiyavarkku niyanthranangalundenn arinjirikkanam. prk allengil lassic baadhicha flaitt apekshakarkku sainyam ippol anumathi nalkunnu. sankeernamallaathathum vijayakaravumaya cornia refractive shasthrakriyaykk oru elavu aavasyamilla, mathramalla ithu vivaramaayi maathram rekhappeduthunnu.
pailattumarkko vidyaarthi naavika eviyettarmaarkko naavika flaitt offeesarmaarkkum us oopparettarmaarkkum aircrovinum, preopparetteevu refractive maanadandangal paalikkunnundennu karuthukayum rogashanti prakriyayil sankeernathakalonnum neridendi vannilla, lakshanangalonnumillatha, ellah marunnukalum ozhivaakkukayum avarude staanderd vision testtukalil vijayikkukayum cheiyunnu. oru padanatthil, pii. aarr. keey ulla 968 naavika vimaanangalil 967 perum nadapadikramatthinu sesham parakkunnathulppedeyulla dutyilekku madangi. vaasthavathil, yuu.ezz. flaitt school prathyeka ooppareshan pariseelanavum ulppede nalla thiruthappedaatha kazhcha aavasyamulla currier pathakal pinthudaraan uddeshikkunna naavika akkadami midshipmenmaarkk naavikasena ippol deseeya naavika medical sentaril soujanya prk, lassic sasthrakriya vaagdaanam cheiyunnu.
yuu.ezz. prk, lassic ennivayude upayogathinu vyomasena amgeekaaram nalkunnu. 2000 muthal yuu. ezz. eiii. eph wilford haal medical sentaril eviyettarmaarkkaayi pii. aarr. keey nadathunnundu. varshangalayi kooduthal airmaanmaare anuvadikkukayum 2004-ll usaf eviyettarmaarkku laasikkine amgeekarikkukayum avarkk parakkaan kazhiyunna vimaanangalude tharatthil paridhikalode. 2007ll aaa paridhikal neekki. ettavum aduthide 2011-ll usaf prograam vipuleekarichu, ithu kooduthal airmanmark shasthrakriyaykk yogyatha nedunnathu eluppamaakki. nilavile airmanmar (active duty, eyar reserve gadakangal ennivaykku arhathayund) eathu dooad refractive sarjari sentarilum amgeekritha shasthrakriyayaan. yogyathayillaatha airmanmark ippozhum oru sivilian sarjan swantham chelavil sasthrakriya nadatthaan kazhiyum, pakshe aadyam amgeekaaram nalkanam (amgeekaaram athe usaf-rs prograamine adisthaanamaakkiyullathaanu). aaa vibhagangalil pedaattha mattullavar (i.iii. pailat sloat thedunna apekshakarkku) ippozhum sasthrakriya nadatthaan thiranjedukkaam, pakshe usaf ozhivakkal guidinu anusrithamaayi maanadandangal paalikkanam. aaa apekshakarkku avarude medical flaitt screening appoyintment samayat avar elavu maanadandangal paalikkunnundo ennu nirnnayikkaan essy-kalil vilayiruthappedum.
bhooribhaagam rogikalilum, myopia thiruthunnathinulla surakshithavum phalapradavumaaya prakriyayayi prk theliyikkappettittund. nilavil parishkaricha saankethikavidyakalum badal nadapadikramangalum upayogikkunna mattu rajyangalumaayi prk ippozhum vikasichukondirikkukaya. eee nadapadikramangalil palathum yuu. esil anweshanathilaanu.ezz. prk reversible allaathathinaal, prk pariganikkunna oru rogi avarkk prathyekamaayirikkaavunna nettangaleyum baadyathakaleyum kurichu arivodeyulla theerumaanam edukkunnathil sahaayathinaayi oru nethraparipalana pariseelakane bandhappedaan shupaarsha cheiyunnu.
charithram.
aadyathe pii. aarr. keey. nadapadikramam 1987ll doow. theo sealer, pinneedu germmaniyile berlinile soujanya sarvakalashaala medical sentaril. 1996ll masaachyusets aii aandu iyar infermaryil nethrarogavidagdhayum refractive sarjan aaya dimitri azar aanu lasekkinu samanamaaya aadyathe nadapadikramam nadathiyathu. doow. 1998ll lazer epithelial keratomilyoosis enna padatthinu lassec enna padam nalkikkond puthiya shasthrakriya saankethikavidyayekkurichu aadyamaayi oru shaasthreeya prasidheekaranam ezhuthiyathu itaaliyan sarjanaaya massimo camelinaanu.

