Ukuqiniswa kwamehlo nge-laser kuphumelele kakhulu endleleni izigidi zabantu ezibhekana ngayo nezinkinga zokubona, kunikeza enye indlela ethembekile yezibuko namalensi okuxhumana. Ezingqondweni zale nkinga kukhona umqondo welensi ye-laser, lapho izinhlelo eziphambili ze-laser ziguqula i-cornea ukuze kulungiswe ukuthi ukukhanya kugxile kanjani ku-retina. Le nqubo inciphisa noma iphinde iqede ukuncika ezintweni zokubona ezilungisayo, inikeze iziguli inkululeko yokubona engakaze ibonwe. Ukunemba kwamapulatifomu e-laser amanje kuvumela odokotela ukuthi bakhe izicubu ze-cornea ngokunemba okulinganiselwe ku-micron, benze inqubo ngayinye ihambisane nomuthi wokubona oyingqayimbana nesakhiwo samehlo sesiguli. Ngenxa yalokho, izinqubo zelensi ye-laser seziyizinyathelo ezicwaningwe kakhulu futhi ezicwengwe kakhulu emkhakheni wezifo zamehlo, ngezigidi zokuphumelela okwenziwa emhlabeni wonke minyaka yonke. Kubantu abacabanga ukuhlinzwa okubhekene nokubona, ukuqonda izinto ezihlukahlukene zezinketho zelensi ye-laser kuyisinyathelo sokuqala sokwenza isinqumo esinolwazi mayelana nempilo yokubona yabo.

I-LASIK, noma i-laser-assisted in situ keratomileusis, iseyona inqubo ye-laser lens eyenziwa kakhulu futhi ihilela ukudala i-corneal flap encane ngaphambi kokuguqula izicubu ezingaphansi nge-excimer laser. Le flap ibe isibuyiselwa endaweni yayo, ivumela ukululama okusheshayo kombono kanye nokungakhululeki okuncane, neziguli eziningi zithola umbono osebenzayo kungakapheli amahora angu-24. Abazongenela i-LASIK ngokuvamile bane-myopia, i-hyperopia, noma i-astigmatism ezingeni eliphakathi nendawo, kanye ne-corneal thickness eyanele kanye nokukhiqizwa izinyembezi okunempilo. Ukuthandwa kwale nqubo kuvela esikhathini sayo esisheshayo sokuphulukisa kanye nokungavamile okuphansi kobuhlungu ngemuva kokuhlinzwa, nakuba iziguli kufanele zigweme ukuhlikihla amehlo azo esigabeni sokuqala sokuphulukisa. Kulabo abane-corneas ezincane noma izindlela zokupheka eziphakeme, i-PRK (photorefractive keratectomy) ihlinzeka ngendlela ehlukile ngokukhipha i-corneal epithelium ngokuphelele ngaphambi kokusebenzisa i-laser ngqo ebusweni. Ukululama kusuka ku-PRK kuthatha isikhathi eside, kuvame ukudinga izinsuku ezimbalwa kuya evikini ukuze kuphinde kukhiqizwe i-epithelium, kodwa kuyakhipha izinkinga ezihlobene ne-flap futhi kukhethwa iziguli ezibandakanyeka ezemidlalo yokuxhumana noma imisebenzi engozini enkulu yokulimala kwamehlo. I-SMILE, noma i-small incision lenticule extraction, imelela isizukulwane esisha sokuhlinzwa kwe-laser lens esisebenzisa i-femtosecond laser ukudala i-lenticule ngaphakathi kwe-cornea, ebe isikhishwa ngokusebenzisa umgodi omncane. Le ndlela engeneleli kancane igcina amandla amaningi e-corneal biomechanical futhi iyasebenza ikakhulukazi ekwelapheni i-myopia ne-astigmatism kuze kube sezingeni eliphakathi. Noma iyiphi yalezi zinqubo ithembele ezinhlelweni ezihlakaniphile zokubona, okuhlanganisa nezingxenye ezifana ne-ZnSe lens yokulethwa kwe-infrared laser kanye nokulawula ibhande okunembayo, eziqinisekisa ukusatshalaliswa kwamandla okungaguquki ngesikhathi sokukhipha izicubu.

Uma kuqhathaniswa lezi zindlela zokusebenzisa i-laser emalensi, ukukhetha kuncike kakhulu ezintweni zomuntu siqu okubalwa ukujiya kwe-cornea, ukuzinza kwe-prescription, kanye nezinto ezithinta indlela yokuphila. I-LASIK inikeza ukululama okusheshayo futhi ilungele iziguli eziningi, kanti i-PRK inikeza indlela ephephile kulabo abane-cornea ezincane noma abasengozini enkulu. I-SMILE ihambela iziguli ezifuna inqubo engadingi i-flap kanye nokuncipha kwezinkinga zamehlo omile, nakuba ukutholakala kwayo kungase kube nomkhawulo ngenxa yobuchwepheshe buka-surgeon kanye nokutholakala kwemishini. Izinhlelo ze-laser ezisetshenziswa kulezi zokuhlinza zivame ukuba nezinto ezithuthukisiwe zokubumba umgqomo, okubalwa i-Powell lens, eshintsha imigqomo ye-Gaussian laser ibe imigqa efanayo ukuze kube nokuhlukana okungaguquki. Ukuqonda lezi zici zobuchwepheshe kusiza iziguli ukuba ziqonde ukuthi kungani ukuhlolwa okuphelele ngaphambi kokuhlinzwa kubalulekile ukuze kufaniswe inqubo efanele nezidingo zamehlo azo. Abahlinzayo bacubungula nezinye izinto ezifana nosayizi we-pupil kanye ne-corneal curvature, njengoba lezi zici zithonya kakhulu amathuba ezinkinga zokubona ebusuku njengokukhanya okukhanyayo noma ama-halos. Ekugcineni, ukuhlukahluka kwezinketho ze-laser lens kuqinisekisa ukuthi iziguli eziningi ezifanelekayo zingathola inqubo ehambisana nemigomo yazo yokubona kanye nemikhawulo yomzimba.

Ubudala budlala indima ebalulekile ekunqumeni indlela efanele kakhulu ye-laser lens, njengoba inqubo yemvelo yokuguga kwamehlo ithinta ukuzinza kokukhanya, ukuvumelana kwe-lens, nokuqala kwe-presbyopia. Ezigulini ezincane ezingaphansi kweminyaka engu-40, i-LASIK noma i-SMILE ivame ukunconywa ukwelapha i-myopia kufika ku-approximately -9 diopters, uma ubukhulu be-cornea nempilo yonke yamehlo kuvunyelwe. Ezimweni ze-myopia ephezulu edlula lesi sigaba, odokotela bavame ukukweluleka ukuba ungasebenzisi i-laser lens surgery ngenxa yengozi ye-ectasia futhi esikhundleni salokho baphakamise ama-phakic intraocular lenses, agcina i-lens yemvelo ngenkathi elungisa umbono. Iziguli ezincane ngokuvamile zithola imiyalelo ezinzile nokululama okusheshayo, okubenza babe abazongenela kahle izinqubo ezinikeza imiphumela yesikhathi eside ngokungaphazamiseki okuncane ezimpilweni zabo ezisebenzayo. Ukusetshenziswa kwesistimu ye-collimating laser ekumapheni okuhlola ngaphambi kokuhlinzwa kuqinisekisa ukuthi i-curvature ne-thickness ye-cornea iyalinganiswa ngokunemba okungajwayelekile, okwengeza ukunemba kokuhlinzwa kuleli qembu. Kodwa-ke, ngisho naseqenjini elinjalo, ukuhlola okuphelele kwe-corneal topography nekhwalithi ye-tear film kuyimpoqo ukugwema izinkinga ezifana ne-dry eye noma i-irregular astigmatism.

Kubantu abaneminyaka ephakathi kuka-40 kuya ku-50, ukuvela kwe-presbyopia kudinga indlela ehlukile yamasu, njengoba ilensi yemvelo iqala ukulahlekelwa ikhono layo lokuhlala. I-Monovision LASIK, lapho iliso elilodwa lilungiswa ukuze libone kude kanti elinye libone eduze, inikeza isixazululo esidumile esinciphisa isidingo sezibuko zokufunda ngenkathi kugcinwa umbono ohlangene osebenzayo. Ngakolunye uhlangothi, i-refractive lens exchange, ifaka ilensi yemvelo nge-intraocular lens yokwenziwa, iphatha ngempumelelo kokubili iphutha lokubona kanye ne-presbyopia ngesikhathi esisodwa. Iziguli zaleli qembu lobudala kumele zicabangele izinzuzo nezingozi phakathi kwezinqubo ze-laser lens nezinqubo ezisekelwe kulensi, zicabangele izinto ezifana nokuzwela kombala, umbono wokujula, kanye nokuvela kwe-cataracts esikhathini esizayo. Kulabo abadala kuno-55, ukuhlinzwa kokushintsha ilensi kuvame ukukhethwa kunokuba izinqubo ze-laser lens ngoba iphatha i-opacity yelensi ehlobene nobudala ngenkathi ilungisa umbono, inikeza isixazululo esibanzi esesikhathini eside. Inqubo yokwenza izinqumo kubantu abadala nayo ihlanganisa ukuhlola ingozi yokuhlinzwa kwe-cataract esikhathini esizayo, njengoba izinqubo ze-laser lens elensini ecacile azivimbeli isidingo sokususwa kwe-cataract kamuva empilweni. Odokotela abahlinzayo bangase futhi batuswe i-monovision noma i-multifocal IOLs ngesikhathi se-refractive lens exchange ukuze kuthuthukiswe imiphumela yokubona kuzo zonke iziqongqo, baqinisekise ukuthi iziguli zigcina ukuzimela ezibukweni emisebenzini yansuku zonke.

Ngaphambi kokuba kwenziwe noma yiluphi uhlobo lwenqubo ye-laser lens, ukuhlolwa okunzulu ngaphambi kokuhlinzwa kubalulekile ukukhomba izimo ezingavunyelwe ezingalimaza ukuphepha noma imiphumela. I-corneal topography iyisisekelo salokhu kuhlolwa, ihlola izindawo zangaphambili nangemuva ze-cornea ukuze kuqedwe izimo ezifana ne-keratoconus, okungenza ukuhlinzwa kwe-laser lens kube yingozi ngenxa yengozi yokuncipha okuqhubekayo nokulahlekelwa umbono. Ubukhulu be-residual stromal bed bungomunye umkhawulo obalulekile; odokotela abahlinzayo badinga ubukhulu obuncane ngemuva kokudala i-flap noma ukukhipha i-lenticule ukuze kuqinisekiswe ukuzinza kwe-cornea yesikhathi eside. Iziguli ezine-corneas ezincane zivame ukwelulekwa ukuba zingayi ku-LASIK futhi zingase ziqondiswe ku-PRK noma ezinye izindlela ezingasebenzisi i-laser njengama-lens okubuyisela ukubona afakwayo. Ukuhlolwa kwe-tear film kusetshenziswa izivivinyo ezifana ne-Schirmer's test noma i-tear breakup time kusiza ukuxilonga isifo samehlo esomile, esingase senziwe kabi ukuhlinzwa kwe-laser lens, okuholela ekungakhululeki okungapheli nokushintshashintsha kombono. Isohlobo esibi esingaphenduli ekwelashweni siyisimo esingavunyelwe esingavunyelwe, njengoba singabambezela ukuphulukiswa futhi sinciphise ukwaneliseka kweziguli. Ngaphezu kwalokho, izimo zesistimu ezifana nezifo ezizenzakalelayo, isifo sikashukela esingalawulwa, noma ukukhulelwa kungase kuvimbele ukuhlinzwa ngenxa yokulimala okubambekayo kwesilonda noma izinguquko zamahomoni ezithinta ukubuyekezwa.

Ezinye izivivinyo ezibalulekile ngaphambi kokuhlinzwa zihlanganisa ukukala usayizi womfundi ngaphansi kwezimo zokukhanya okubuthakathaka, njengoba abafundi abakhulu bangandisa ingozi yokuphazamiseka kombono ebusuku ngemva kokuhlinzwa kwe-laser lens. I-Wavefront aberrometry ivame ukusetshenziswa ukukhomba iziphambeko ezi-higher-order ezingathinta uhlelo lokwelashwa, okuvumela odokotela abahlinzayo ukuthi benze uhlelo lokukhipha izicubu lube olungcono kakhulu ukuze uthole ikhwalithi enhle yokubona. Iziguli ezinomlando we-herpes simplex keratitis noma ukuphuka kwe-corneal okuphindaphindayo zidinga ukucatshangelwa ngokucophelela, njengoba ukwelashwa nge-laser kungase kuvuselele ukukhishwa kwamagciwane noma kubambezele ukuphulukiswa kwe-epithelial. Ukubuyekezwa okuningiliziwe kohlu lwemithi yesiguli nakho kuyadingeka, njengoba imithi ethile efana ne-isotretinoin noma i-amiodarone ingathinta ukuphulukiswa kwe-corneal futhi yandise ingozi yezinkinga. Inqubo yangaphambi kokuhlinzwa ngokuvamile ihlala amasonto ambalwa futhi ihlanganisa ukubonisana lapho udokotela ohlinzayo ekhuluma ngezinto ezingokoqobo ezilindelekile, imiphumela emibi engaba khona, kanye nokubaluleka kokuthobela ukunakekelwa ngemva kokuhlinzwa. Ngokuhlola ngokucophelela lezi zici, ochwepheshe bokunakekelwa kwamehlo banganciphisa izingozi futhi bakhulise amathuba empumelelo ye-laser lens, baqinisekise ukuthi abazongenelwa kuphela abafanelekayo abaqhubeka nokuhlinzwa. Ezigulini ezingazona abazongenelwa izinqubo ze-laser lens, izinketho ezifana ne-phakic IOLs noma ukushintshwa kwe-refractive lens kuhlala kuyizindlela ezisebenzayo zokufeza ukuzimela ekuboneni.

Izinqubo ze-laser lens zinemiphumela ephakeme kakhulu, lapho iningi labantu libona kahle kakhulu (20/20 noma kangcono) futhi libika ukuthuthuka okukhulu ekuphileni kwabo. Isikhathi sokululama sifushane kakhulu ku-LASIK ne-SMILE, lapho abantu abaningi bebuyela emsebenzini kungakapheli usuku olulodwa noma ezimbili futhi beqhubeka nemisebenzi yomzimba kungakapheli isonto. Ukunemba kwamalaser e-excimer ne-femtosecond anamuhla, avame ukusebenzisa izingxenye ezisezingeni eliphezulu zokubona njenge-ZnSe lens ukudlulisa amandla ngempumelelo, kunciphisa umonakalo ezindaweni ezizungezile futhi kuthuthukisa ukuphepha. Iziguli zijabulela ukunciphisa ukuncika ezibukweni nasezintweni zokubona, okudala ukonga ezindlekweni zezibuko nokukhululeka ekugcineni izinto zokubona nsuku zonke. Inqubo ngokuvamile yenziwa ngaphandle kokulaliswa esibhedlela ngaphansi kwe-anesthesia yendawo, idinga imizuzu embalwa kuphela iliso ngalinye futhi ibangele ubuhlungu obuncane. Kodwa-ke, njenganoma yikuphi ukuhlinzwa, ukuhlinzwa kwe-laser lens kunezinhlobo zezingozi ezingenzeka nemiphumela engemihle okufanele iziguli ziqonde ngaphambi kokuvuma. Iso elomile yikho okwenzeka kakhulu, okwenzeka ezigulini ezingafika ku-40% esikhathini sokuqala ngemuva kokuhlinzwa, nakuba ngokuvamile kulungiswa ngezinyembezi zokwenziwa noma izinto zokuvimbela izinyembezi ezingqimeni ezinyangeni ezimbalwa.

Ezinye iziphumo ezihlangene ezingenzeka zihlanganisa ukukhanya okubabazayo, imibuthu, nezinkanyezi ezizungeze izibani ebusuku, ikakhulukazi ezigulini ezinamapupil amakhulu noma izindlela zokwelapha eziphakeme. Ukungalingani noma ukweqisa kungenzeka, okudinga inqubo yokuthuthukisa ezingxenyeni ezincane zezimo, kanti ukubuyela emuva kungaholela ekubuyeni kancane kancane kwephutha lokubona eminyakeni. Iziyobisi ezingavamile kodwa ezibi njengokuhlehlisa isikhumba, ukutheleleka, noma i-corneal ectasia kugcizelela ukubaluleka kokukhetha udokotela onolwazi nokulandela yonke imiyalelo yangaphambi nangemva kokuhlinzwa. Uma kuqhathaniswa nezinketho ezingezona i-laser njengezibuyekezi ezibuyekeziwe (ICL) noma ukushintshwa kwezibuyekezi ezibuyekeziwe (RLE), izinqubo zezibuyekezi ze-laser zinikeza inzuzo yokuba zingenele kancane futhi zigcine isibuyekezi semvelo, okubaluleke kakhulu ezigulini ezincane. Ama-ICL angabuyiselwa emuva futhi ahlinzeka ngekhwalithi yokubona enhle kakhulu ye-myopia ephezulu, kanti i-RLE ibhekana nephutha lokubona kanye ne-presbyopia noma i-cataracts kubantu abadala. Isinqumo phakathi kwezindlela ze-laser nezindlela ezingezona i-laser kufanele siqondiswe yingxoxo ephelele nodokotela wamehlo, ongakwazi ukukala izinzuzo nezingozi ngokusekelwe kumphumela wokubona okhethekile wesiguli. Kubaningi, ukulula kanye nemiphumela engalindelekile yokuhlinzwa kwezibuyekezi ze-laser kuyenza kube ukukhetha okukhangayo, kodwa ukuqonda uhla oluphelele lwemiphumela engenzeka kubalulekile ukuze kube nemibono engokoqobo.

Iziguli ezicubungula ukuhlinzwa nge-laser lens kufanele ziqaphe ukuthi le nqubo ilungisa amandla okubuyisa ukukhanya kwe-cornea kodwa ayiyeki izinqubo zemvelo zokuguga kwamehlo, okubandakanya ukuthuthukiswa kwama-cataract. Uma ama-cataract eseqalile ukwakheka, avame ukwenzeka ngemva kweminyaka engu-60, iziguli eziye zathola ukuhlinzwa nge-laser lens ekugcineni zizodinga ukususwa kwe-cataract nokufakelwa kwe-intraocular lens, njenganoma yimuphi omunye umuntu. Ubukhona be-LASIK yangaphambili noma i-SMILE flap bungathinta indlela yokuhlinzwa yokukhipha i-cataract, njengoba ubuqotho be-cornea kufanele buhlonishwe ngesikhathi sokusika nokubalwa kwamandla e-intraocular lens. Odokotela abahlinzayo kufanele bacabangele ukuguqulwa kwe-cornea kwangaphambili lapho bethatha amandla afanele e-IOL, bavame ukusebenzisa amafomula athuthukile noma idatha yomlando ukuze bagweme izimangaliso zokubuyisa ukukhanya ngemva kwe-cataract. Ngaphezu kwalokho, ukulungiswa kwe-presbyopia kuhlala kuyinto okufanele icatshangelwe iziguli ezingakabi nama-cataract, kunezinketho ezifana ne-monovision LASIK noma ama-accommodating IOLs atholakalayo ukuze kugcinwe umbono oseduze naphakathi. Kulabo abakhetha ukuhlinzwa nge-laser lens eminyakeni yabo yobudala engama-20 noma engama-30, ukuhlela i-presbyopia kanye nokuhlinzwa kwe-cataract akuyona into esheshayo kodwa kufanele kube yingxenye yohlelo lombono wesikhathi eside. Ukuqina kokulungiswa kwe-laser kuhle kakhulu, njengoba izifundo zibonisa imiphumela ezinzile emashumini eminyaka ngemva kokuhlinzwa, uma nje iresiphi yokuqala yayinzile futhi inqubo yenziwa kahle.

Ukuqhubeka kobuchwepheshe bezokukhanya kuyaqhubeka nokuthuthukisa ukuphepha nokunemba kwezinqubo ze-laser lens, nabakhiqizi abanjengo-Honray Optic abanikela izingxenye ezisezingeni eliphezulu njengama-lens okunemba kanye ne-beam-shaping optics asetshenziswa ezinhlelweni ze-laser zokuxilonga nokuhlinzwa. Lezi zinto ezintsha zivumela ukwelashwa okwenziwe ngokwezifiso kakhudlwana, okuhlanganisa i-topography-guided noma i-wavefront-optimized ablations ehlisa ukukhubazeka okuphezulu futhi yandisa ukuzwela kokungafani. Iziguli kufanele futhi zicabange ukuthi ukuthuthukiswa okuzayo ekuhlinzeni kwe-refractive, njengokufakelwa kwe-lenticule noma i-corneal inlays, kungandisa izinketho ezitholakalayo zokulungisa umbono ngemuva kokuqala kokulungiswa kwe-laser. Kubantu abaneminyaka engama-40 nengama-50, ukukhetha phakathi kokuhlinzwa kwe-laser lens nokushintshwa kwe-refractive lens kuvame ukunciphisa ekutheni ngabe bazimisele yini ukwamukela ukulahlekelwa kwe-accommodation ukuze bathole isixazululo esihlala njalo se-presbyopia. Kuyanconywa ukubuyekeza ucwaningo lwakamuva futhi uthintane nodokotela ohlinzayo ohlala esesikhathini nezindlela nobuchwepheshe obuqhubeka buvela.IzindabaIkhasi elivela ku-Honray Optic linikeza imininingwane ngezixazululo ezintsha zokubona ezingathonya izindlela zesikhathi esizayo zokuhlinzwa kwe-refractive. Ekugcineni, isiguli esinolwazi olwanele esicabanga ngezinzuzo ezisheshayo kanye nomkhondo wesikhathi eside wezempilo yokubona kwabo singcono kakhulu ekukhetheni inketho ye-laser lens ehambisana nendlela yabo yokuphila kanye nokulindela kwabo.

Ukuvumelana nokuhlinzwa kwe-laser lens kuyisinqumo somuntu siqu okufanele senziwe ngokubambisana nodokotela wamehlo oqeqeshiwe ongahlola izidingo zakho ezithile, i-anatomy, nezinjongo. Izinhlobonhlobo zezinqubo ezitholakalayo, kusukela ku-LASIK ne-PRK kuya ku-SMILE nangaphezulu, ziqinisekisa ukuthi kunesixazululo esenziwe ngokwezifiso kweziguli eziningi, kodwa ukuhlolwa okunzulu kuphela okunganquma indlela ephephe kakhulu futhi ephumelela kakhulu. Ukuhlolwa ngaphambi kokuhlinzwa, okuhlanganisa i-corneal topography, i-tear film analysis, kanye ne-wavefront aberrometry, kunikeza idatha edingekayo ukuze kwenziwe uhlelo lokwelashwa futhi kugwenywe izimo ezingafaneleki njenge-corneas ezincane noma iso elomile kakhulu. Ngenkathi ukuhlinzwa kwe-laser lens kunikeza amazinga empumelelo aphakeme kanye nenkululeko yokubona eshintsha impilo, iziguli kufanele zihlale ziqotho mayelana nemiphumela engase ibe khona kanye nesidingo sokungenelela esikhathini esizayo njengokuhlinzwa kwe-cataract noma ukulungiswa kwe-presbyopia. Imboni yezokubona iyaqhubeka nokuthuthuka, nabakhiqizi bezingxenye eziqondile beqhubela phambili ukuthuthukiswa ezinhlelweni zokulethwa kwe-laser namathuluzi okuxilonga athuthukisa imiphumela yokuhlinzwa. Kulabo abafuna ulwazi olwengeziwe,IKHAYAikhasi le-Honray Optic linikeza ukubuka konke kobuchwepheshe be-optical obusekelayo ukuhlinzwa kwe-refractive yesimanje, kanti iMayelana Nathi isigaba sichaza ukuzibophezela kwenkampani ekuqiniseni ukukhiqizwa kwe-optical. Ngokuzihlonyisa ngolwazi nokufuna isiqondiso sochwepheshe, ungakwazi ukuzulazula ezinkethweni zamalensi e-laser ngokuzethemba nokucaca, ekugcineni ufeze imiphumela yokubona oyifanelekayo.