サンデー毎日で取材を受けました。111.112ｐ：お知らせ

２０１３年４月７日発売のサンデー毎日で取材を受けました。

１１１，１１２pに掲載されています。

Please view a video of  operation on the right side.

The operation includes 3 steps. Note: The Video shows Step 2 and 3.

Step 1. Apply the ring to fix the eye movement.
Step 2. The photochemical vaporization, laser procedure starts under the observation of my college and I. We monitor the depth of the vaporization throughout the procedure as every eye is unique.
Step 3. Remove the ring and apply eye drops  which includes MMC and a protective contact lens which will stay in place for a week.

Video 1: Broad Beam laser (superficial PRK) Shows an actual procedure

Reasons for development

I created the Broad Beam / Superficial PRK operation out of concern for my patients. I wanted a simple procedure which will give my patents a better quality of life.
This is a Russian Broad Beam Laser not an American laser with its inherent central Island problems.
All Lasik Doctors know the inherent risks of Lasik.
As you can see in the video the Broad Beam Laser is a solid laser and not a scanning  laser.
It photo chemically vaporizes gradually and smoothly creating a refractive surface which no other operation in the world can provide at this point in time.
Each ring has a slightly different amount of energy distribution which is customized for different eye profiles.

Please consider your patients and their vision 20 plus years from now.

My name is Dr. Kodo Okuyama.  You can find more information at  Sangubashi.com

I was operated on by Prof. Fyodrov  using RK (Radial Keratotomy) 27 years ago.

The early form of RK was a one step incision (single depth incision) which I now realize helped to create a multi focal refractive surface for me.

The later RK operations included two or three step incisions of various depths which were more effective however the results had a tendency to be mono-focal.

I am now 63 years old and still have wonderful vision. I was inspired by Prof. Fyodrov’s dream to provide and develop an operation which will have very few side effects, this lead me to develop Flapless Lasik ( Superficial PRK / Broad Beam Laser plus MMC, anti haze agent ).

I am very happy with the results, minimal risk and the multifocal quality of my operation.

Below are pictures of my left and right Keratotopograms

Please consider your patients and their vision 20 plus years from now.

Picture E: Keratotopogram   My Right Eye, Post RK 27 y.a.

Picture F: Keratotopogram   My Left Eye, Post RK 27 y.a.

Purpose:

To report a case of spectacle-free reading in presbyopic patient post Broad Beam laser operation.
(Superficial PRK).

Methods:

A 46 year old man, who had his left eye operated on using superficial PRK 5 years ago, in 2005.

His right eye has not been operated on and he has continued to use the same power contact lens.
Use of the Profile 500 created by the Fyodrov Institute for the superficial PRK. Keratotopography TMS-ⅡN and other routine exams pre and post refractive surgery.

Picture A: Broad Beam laser (superficial PRK)

Broad Beam Laser:

Comparative to superficial PRK but a non scanning laser.
Plus points:

• Create a multifocal refractive surface.
• Less risk of infection.
• Less risk of irregular astigmatism.
• Less risk of keratectasia.

Picture B: Keratotopogram of the patient left eye

Conclusions:

Post operated left eye using superficial PRK was successful with both near and far vision.

This finding leads me to hypothesize that I have created an aspheric refractive multifocal corneal surface similar to a multifocal refractive IOL.

Points to consider:

1.Broad Beam Laser using one very powerful , solid multi intensity laser which creates a kind of photochemical vaporization.
2.Multifocal abrasion via smooth laser energy distribution to create a multifocal refractive surface.
3.Transepitherial superficial PRK is a One Step operation combining both the epitherial and stromal mode.
4.Flapless operation gives me the ability to use the greater (diameter and depth) refractive corneal surface to maximize the patients potential multifocal refractive surface.

In technical collaboration with the Fyodorov Eye Microsurgery Institute, Moscow,

The Sangubashi Eye Clinic, Shimouma Setagayaku,Tokyo, has developed Flapless Lasik ( corneal abrasion is made by a broad beam laser, and does not use any knife or surgical instrument ) myopic refractive surgery using only an excimer laser.

The Fyodorov Institute has conducted more than 100,000 cases of PRK treatment since 1987.

In brief, Flapless Lasik is myopic refractive surgery, by flattening the convex curve at the center of the cornea through abrasion of an optical zone of about 6.7 mm in diameter with a volume three dimensional excimer laser.

Due to using Flapless Lasik, we reached a high accuracy rate in refractive effect of more than 93% and get as close as possible to 100% using regenerative tissue control during post operative care.

It is highly safe and effective.

Depending on the degree of myopia and corneal thickness, the depth and the area of abrasion vary for different patients.

In cases of extreme myopia and very thin cornea, Flapless Lasik re-operation may be called for.

• The Process of Lasik Flapless（Movie）

• The Process of Lasik（Movie）

Please contact:

The Sangubashi Eye Clinic

2-21-26 Shimouma Setagaya-ku, Tokyo 154-0002
Refractive Surgery Institute
Tel.: (03) 3411-0005 Fax.: (03) 5486-0120
Email:kodo@e-intralasik.com

Price list of Flapless Lasik

Dr.Kodo Okuyama

1974 Graduated from the Second Moscow Institute (Moscow University of Medcine).
Received a Russian Medical licence.
1975 Received a Japanese Medical licence.
1976-1983
Worked at Fujimi Hospital and Tokai University of Medicine.
1983 Received Refractive eye surgery (RK) from Prof.Fyodrov Moscow.
1983 Opened Sangubashi Eye Clinic (The first clinic in Japan which specialized in Refractive eye surgery).
1989 First farsightedness operation in Japan at our clinic.
1992 PRK (Photo Refractive Keratoplasty) at our clinic
1995 Received a PHD in Refractive Eye surgery.
1996 Received a specialist licence in Ophthalmology (Russia).

Carier highlights: Guest Prof. at Kazakh Medical University.
Ex W.H.O research center fellow.
Editor of Eye Surgery Journal.

Dr.K.Okuyama and his Clinic.
Sangubashi Eye Clinic are now using the forth generation operation Developed by Dr.K.Okuyama.
The generations are as fellows;
1. RK 1984-1991
2. PRK (Super-PRK) 1992-2004
3. Flapless Lasik（Superficial-PRK+MMC） 2005-
Generation 4 was developed by Dr.K.Okuyama and takes the operation to the next level in tissue care.

The Sangubashi Eye Clinic was founded as the first refractive eye surgery clinic in Japan in 1983.

Refractive corneal surgery corrects nearsightedness, farsightedness, astigmatism and helps presbiopia, so called refractive errors by changing of corneal curvature using RK, PRK, Lasik,
Intralasik or Flapless Lasik  operations.

As a clinic specialising in refractive eye surgery.
we pay attention to the following:

1) Testing on myself, members of my family and staff. Checking to make sure it’s safe and effective.

2) Visual Acuity: using cutting edge technology to give patients the best results possible.

3) Quality of vision: to enhance everyday activities, jobs, sports etc.

In 2011 our Clinic celebrated it’s 28th anniversary, until now more than 20,000 eyes have been operated on and not one eye lost.

More than 200 Japanese eye doctors have attended our clinical conferences.
Refractive corneal operations have become more popular and accepted as a common part of modern medicine.

201１年9月17日～21日の第28回欧州白内障及び屈折手術学会に参加してきました。

メインテーマの一つに、クロスリンキング、英語表示でCXLが、注目を浴びました。

米国FDAが、9月に認可したとのホットニュースが、私の会場での質問を通じ明らかにされました。日頃から危惧していたレーシック後の角膜拡張症の対策として朗報です。レーシックの増加と共に、角膜拡張症増加の間接的な証でしょうか。

わが国からは、京都府立医科大学の木下博士による角膜内皮細胞移植法が、大きな反響を呼びました。提供眼から培養・増殖した内皮細胞を、博士等が開発した特殊な溶液と共に前房に注入し移植を成功させる方法です。培養・増殖した内皮細胞がシート状になったものを張り付けるのが、従来の方法なのですが、上手く張り付けるのが困難であったそうです。木下教授のたゆまない努力に、頭が下がるばかりです。

参宮橋アイクリニックとしてｅ-ポスター発表は、「ケラトミリョ―ジスとブロード（太い）ビームを使用したＴ－ＰＲＫのコンビネーション手術」という演題でした。

ケラトミリョ―ジスという屈折矯正手術を受けた、フィヨドロフ研究所の同僚が、20年が経過し、近視化しているので、更にT-PRKという屈折矯正手術を実施した症例報告でした。

ケラトミリョ―ジスは、初期の屈折矯正手術で角膜に対して一定の深度で切削を加え層状に除去して、角膜の屈折力を弱める方法でした。角膜の厚さが薄くなるので、20年経過した追加手術としては、角膜にフタを作らずに、角膜上皮から蒸散（蒸発）により、さらに屈折力を弱める方法を実施しました。

フタを作ることによる角膜拡張症のリスクは小さいとはいえ、薄い角膜の患者さんにとっては重大な問題です。両眼に実施しましたが、右眼のエンハンスメント効果が少なく、コンフォカル生体顕微鏡検査で強い線維芽細胞の存在を指摘しました。対策として、代謝拮抗剤の使用検討について触れました。

奥ノ山医院のホームページがリニューアルいたしました。

診療に関するお知らせ、学会での発表、などをお知らせしてきます。

どうぞよろしくお願い致します。