What is cTen™

Make your choice consciously

cTen™ (customized Trans-epithelial No-touch) is a customized surgical procedure conceived to remove, in one single step, by means of the excimer laser, only the fraction of epithelium and stroma needed to optimise the quality of vision of the patient. The epithelial healing process normally requires from two to three days.
This smooth process allows for the execution of a fully automated No-Touch laser procedure, free from any intraoperative risk and not requiring any eye manipulation.

Optimizing the quality of vision, minimising invasiveness of the treatment and avoiding surgical complications, drove iVis Technologies to initiate its R&D program.
Our researchers developed the cTen™ procedure (Customized Transepithelial No-Touch), a safer, more effective and less invasive surgical technique.

– Fully customized since your eyes are unique
– Fully no-touch
– Last generation excimer laser and eye tracking systems
– High speed surgery time : a treatment lasts only few tens of seconds
– Low invasiveness (corneal surface procedure)
– Complex cases management (for all the cases where LASIK surgery, glasses and contact lenses fail)
– No Intraoperative pain

Other treatments

Lasik

References

  1. Aslanides lM, Tsiklis NS, Ozkilic E, Coskunseven E, Pallikaris lG, Jankov MR. The effect of topical apraclonidine on subconjunctival hemorrhage and flap adherence in LASIK patients J Refract Surg. 2006 Jun;22(6):585 8.
  2. Mi, et al. Adhesion of laser in situ keratomileusis like flaps in the cornea: Effects of crosslinking, stromal fibroblasts, and cytokine treatment. J Cataract Refract Surg. 2011 Jan;37(1):166 72.
  3. Canto AP,Vaddavalli PK, Yoo SH, Culbertson WW, Belmont SC. J Protective effect of LASIK flap in penetrating keratoplasty following blunt trauma. Cataract Refract Surg. 2011 Dec;37(12):2211 3.
  4. Jin GJ, Merkley KH. Laceration and partial dislocation of LASIK flaps 7 and 4 years postoperatively with 20/20 visual acuity after repair. J Refract Surg. 2006 Nov;22(9):904 5
  5. Cheng AC, Rao SK, Leung GY, Young AL, Lam DS (May 2006). "Late traumatic flap dislocations after LASIK". J Refract Surg. 22 (5): 500 4
  6. O'Brart, et al. Laser epithelial keratomileusis for the correction of hyperopia using a 7.0 mm optical zone with the Schwind ESIRIS laser. J Refract Surg. 2007 Apr;23(4):343 54.
  7. Landau, et al. Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with a favorable outcome. J Refract Surg. 2006 Nov;22(9):884 9.
  8. Ursea R, Feng MT. Traumatic flap striae 6 years after LASIK: case report and literature review. J Refract Surg. 2010 Nov;26(11):899 905
  9. Vieira, et al. Late onset Infections After LASIK. J Refract Surg. 2008 Apr; 24(4):411 3
  10. Vesaluoma M, Pérez Santonja J, Petroll WM, Linna T, Alió J, Tervo T (1 February 2000). "Corneal stromal changes induced by myopic LASIK". Invest. Ophthalmol. Vis. Sci. 41 (2): 369 76
  11. Hagele G. Diffuse Lamellar Keratitis DLK and LASIK, All Laser LASIK, Sands of Sahara". Usaeyes.org. 2010 04 12
  12. Alió, J. L.; Pérez Santonja, J. J.; Tervo, T.; Tabbara, K. F.; Vesaluoma, M.; Smith, R. J.; Maddox, B.; Maloney, R. K. (2000). Postoperative inflammation, microbial complications, and wound healing following laser in situ keratomileusis. Journal of refractive surgery (Thorofare, N.J. : 1995) 16 (5): 523 538
  13. Lifshitz T, Levy J, Klemperer I, Levinger S. Late bilateral keratectasia after LASIK in a low myopic patient. J Refract Surg. 2005 Sep Oct;21(5): 494 6
  14. Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk assessment for Ectasia after corneal refractive surgery. Ophthalmology 2008;115:37 50
  15. Sun L, Liu G, Ren Y, et al. (2005). "Efficacy and safety of LASIK in 10,052 eyes of 5081 myopic Chinese patients". J Refract Surg 21 (5 Suppl): S633 5
  16. Sugar A, Rapuano CJ, Culbertson WW, Huang D, Varley GA, Agapitos PJ, de Luise VP, Koch DD. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002 Jan;109(1):175 87
  17. Bailey MD, Zadnik K. Outcomes of LASIK for myopia with FDA approved lasers. Cornea. 2007 Apr;26(3):246 54
  18. Pop M, Payette Y (January 2004). "Risk factors for night vision complaints after LASIK for myopia". Ophthalmology 111 (1): 3 10
  19. Pupil and LASIK Night Vision Halo Starburst". Usaeyes.org. 2010 04 16
  20. Yamane N, Miyata K, Samejima T, et al. (November 2004). "Ocular higher order aberrations and contrast sensitivity after conventional laser in situ keratomileusis". Invest. Ophthalmol. Vis. Sci. 45 (11): 3986 90
  21. Hersh PS, Fry KL, Bishop DS. Department of Ophthalmology, UMDNJ New Jersey Medical School, Newark, New Jersey, USA. “Incidence and associations of retreatment after LASIK″ Ophthalmology. 2003 Apr;110(4):748 54
  22. Smadja D, Reggiani Mello G, Santhiago MR, Krueger RR. “Wavefront ablation profiles in refractive surgery: description, results, and limitations″. Journal of Refractive Surgery. 2012 Mar; 28(3): 224 32.
  23. Sankara Nethralaya; Basuthkar, Subams; Joseph, Roy (Jul Aug 2010). "Ocular aberrations after wavefront optimized LASIK for myopia". Indian Journal of Ophthalmology 58 (4): 307 312

LASIK surgery (Laser-Assisted in situ Keratomileusis) is a two step procedure. Its first surgical step to be executed by the Surgeon is the execution of an intrastromal cut onto the eye’s cornea, using a microkeratome or a femtosecond laser, to create a permanent corneal flap. Once the cut has been performed, the flap is lifted, and the stroma is photo-ablated with an excimer laser. Finally, the flap is in-situ repositioned. It is a quite lengthy procedure requiring surgical manipulations and some intraoperative risks.
LASIK can treat mild to moderate nearsightedness, farsightedness, and astigmatism.

Several international researchers have published, over the years, a number of scientific papers about LASIK and the real rate of unexpected outcomes and complications induced by LASIK.( Outcome of LASIK for Myopia with FDA-approved Lasers – Cornea, volume 26, number 3 April 2007)

Undercorrection or Overcorrection
Overcorrection or undercorrection may be an unexpected outcome of LASIK. Different patients may present different responses to the laser ablation, therefore unexpected overcorrection or undercorrection may occur.

Flap-related Complications
The first step of every LASIK surgery is the creation of the corneal flap that itself can be the cause of some complications and undesired side effects.
Suction and applanation must be applied on the cornea to create the flap, and these steps may in fact cause the bursting of some small blood vessels, resulting in subconjunctival hemorrhage. Furthermore, applying suction onto the eye may cause a temporary dimming of vision in the treated eye. Subconjunctival hemorrhages, however, normally resolve themselves within a few weeks. (1) (15)
A possible serious complication is the displacement of the flap, an event that may occur as late as several years after the surgery. (2) (3) (5) In fact, the corneal flap never heals completely onto the stroma. The flap may also detach, break or fold in. (3) (4) (6) (7)
The displacement or detachment of the flap has been observed up to 7 years after the LASIK treatment. (5) (7) (8)
A further complication is an undesired epithelial ingrowth inside the stromal interface. (5) (10) This complication, according to its degree of seriousness, may require reopening of the flap, cleaning of the interface and its repositioning. (5)
Particles have been observed inside the stromal interface, visible with a slit lamp or a microscope. Their impact on quality of vision may vary according to the nature and quantity of these particles. (10) (11)
Furthermore, the stromal interface may facilitate the insurgence of an inflammatory process called Lamellar Keratitis. (5) (11) (12) Similarly, it may host infections. (9) (15) (16) The solution to these complications may require cleaning the interface, with lifting and repositioning of the flap.

Ectasia
As the cornea will lose structural strength permanently, due to the LASIK flap, a possible complication called Ectasia may develop. Ectasia is a deformation or bulging of the cornea, often progressive, with a consequent insurgence of myopia and deterioration of the quality of vision. (13) (14) (16)
Ectasia is a very dangerous complication that may lead, at worst, to corneal transplant.

Dry Eyes
After LASIK, patients often report dry eyes. This side-effect occurs immediately after the surgery and may endure for several years after treatment. Dry eyes, causing pain and scratchiness, are the most common LASIK complication. (16) (17) Unfortunately, it has been scientifically demonstrated that dry eyes can also decrease visual acuity.
There is currently no cure for dry eyes, with the exception of the temporary relief coming from using artificial tears. (16) (17)

Visual Aberrations
High-order aberrations can be a serious complication induced by LASIK. As we have seen, high-order aberrations are visual problems that cannot be corrected with eye glasses. The most common problems associated with high-order aberrations are: halos, starbursts, ghosting and blurry vision. (16) (17) (18) (20)
Halos generate a blurry stripe around the edge of an object, while starbursts are light rays that depart radially while looking at light sources at night, for example during night driving.
Ghosting occurs when multiple images, or ghost images, are visible. Ghosting may present itself both, at daytime as well as at night.
Blurry vision, that manifests itself like “out of focus″ vision in all lighting conditions, often will appear more severely in dim light. Sometimes, images will only smear in a preferential direction.
A loss of contrast sensitivity, also linked to LASIK and due to the interface between the flap and the stroma, is also proven. Contrast sensitivity is the ability to distinguish clearly details of an object between its light and dark portions. Contrast sensitivity, therefore, is especially important in dim light or fog conditions, when the contrast between objects and their background often is reduced already. Night driving is one activity where poor contrast sensitivity may impair safety. (16) (20)
A report published in the “Ophthalmology″ medical journal in 2003, following a research carried out at the Department of Ophthalmology of UMDNJ – New Jersey Medical School, points out that nearly 11% of patients needed retreatment following LASIK. (21)
Finally, several studies have pointed out that, despite recent technological advancements, Wavefront ablations did not deliver their promise of superior results in terms of visual acuity and correction of lower order aberrations over standard procedures. Furthermore, Wavefront does not appear to have reduced the rate of incidence of LASIK-induced higher order aberrations. (22) (23)

References

PRK

PRK (Photo Refractive Keratectomy )has been the first generation of laser vision correction.
It is a surface ablation surgery executed in two steps. In the first surgical step the Surgeon removes a large area of the corneal epithelium by means of blades, scrubs, alcohol and/or different media. Once the epithelium has been removed, the stroma is photo-ablated with an excimer laser. The epithelial healing process normally requires from three to five days. It is a quite lengthy procedure requiring surgical manipulations and some intraoperative risks.
PRK can treat nearsightedness, farsightedness, and astigmatism.

PRK procedure requires the Surgeon to remove the corneal epithelium, thus inducing possible complications as stromal strias caused by the media used to remove it.
Postoperative vision may fluctuate until complete stabilization that generally occurs within 30 days after surgery.
Some patients, because of healing may experience, rarely, clouded vision to some degree, often referred to as haze. In these cases, haze normally clears within 12 months, with the help of some eyedrops prescribed by your Ophthalmologist. Haze is often linked to UV exposures, for example sunbathing. Therefore, it is recommended to avoid direct sunlight exposure for a minimum of six months after your cTen™ treatment and to wear sunglasses with a total UV-filter.
Other rare visual complications may include halos, a shimmering circle around light sources such as car headlights, glare or increased sensitivity to bright light, and/or double vision (diplopia), described as “ghosting” around an object.

Smile

SMILE (Small Incision Lenticule Extraction)is a surgical procedure derived from LASIK and, like LASIK, is executed inside the stroma.
While in LASIK a single cut is performed to prepare the cornea for the excimer ablation, SMILE procedure requires two distinct cuts in order to create a lenticule of stromal tissue, shaped according to the needed correction, which must be manually removed by the Surgeon. It is a quite lengthy procedure requiring surgical manipulations and some intraoperative risks.
SMILE is meant to treat nearsightedness and astigmatism.

As it is relatively new, the long period effect of this procedure have not been cleared yet. According to FDA premarket approval the unexpected outcomes and complications induced by SMILE are listed as follows (https://www.accessdata.fda.gov/cdrh_docs/pdf15/p150040c.pdf)

Undercorrection or Overcorrection
Overcorrection or undercorrection may be an unexpected outcome of the SMILE procedure. Different patients may present different responses to the laser ablation, therefore unexpected overcorrection or undercorrection may occur. SMILE procedure does not allow retreatments of previously surgically induced overcorrection, undercorrection and/or irregular aberration.

Flap-relatedIntrastromal cut Complications
The first step of every LASIK SMILE surgery is the creation of the intrastromal lenticule to be removedcorneal flap that itself can be the cause of some complications and undesired side effects.
Suction and applanation must be applied on the cornea to create the flapintrastromal lenticule, and these steps may in fact cause the bursting of some small blood vessels, resulting in subconjunctival hemorrhage. Furthermore, applying suction onto the eye may cause a temporary dimming of vision in the treated eye. Subconjunctival hemorrhages, however, normally resolve themselves within a few weeks. (1) (15)
A possible serious complication is the accidental suction loss during the intrastromal cut, which may generate an irregular cut. In such a case a different surgical strategy must be pursued.
A possible serious complication is the displacement of the flap, an event that may occur as late as several years after the surgery. (2) (3) (5) In fact, the corneal flap never heals completely onto the stroma. The flap may also detach, break or fold in. (3) (4) (6) (7)
The displacement or detachment of the flap has been observed up to 7 years after the LASIK treatment. (5) (7) (8)
A further complication is an undesired epithelial ingrowth inside the stromal interface. (5) (10) This complication, according to its degree of seriousness, may require reopening of the flap, cleaning of the interface and its repositioning. (5)
Particles have been observed inside the stromal interface, visible with a slit lamp or a microscope. Their impact on quality of vision may vary according to the nature and quantity of these particles. (10) (11)
Furthermore, the stromal interface may facilitate the insurgence of an inflammatory process called Lamellar Keratitis. (5) (11) (12) Similarly, it may host infections. (9) (15) (16) The solution to these complications may require cleaning the interface, with lifting and repositioning of the flap. [less….]a further surgical intervention that cannot be performed using SMILE procedure.

Ectasia
As the cornea will lose structural strength permanently, due to the LASIK flapthe intrastromale lenticule removal, a possible complication called Ectasia may develop. Ectasia is a deformation or bulging of the cornea, often progressive, with a consequent insurgence of myopia and deterioration of the quality of vision.
Ectasia is a very dangerous complication that may lead, at worst, to corneal transplant.

Dry Eyes
After LASIKSMILE, patients often report dry eyes. This side-effect occurs immediately after the surgery and may endure for several years after treatment. Dry eyes, causing often cause pain and scratchiness, are the most common LASIK complication. (16) (17) Unfortunately, it has been scientifically demonstrated that dry eyesand can also decrease visual acuity.

There is currently no cure for dry eyes, with the exception of the temporary relief coming from using artificial tears. (16) (17)

Visual Aberrations
High-order aberrations can be a serious complication induced by LASIKSMILE. As we have seen, hHigh-order aberrations are visual problems that cannot be corrected with eye glasses. The most common problems associated with high-order aberrations are: halos, starbursts, ghosting and blurry vision. (16) (17) (18) (20)

Halos generate a blurry stripe around the edge of an object, while starbursts are light rays that depart radially while looking at light sources at night, for example during night driving.

Ghosting occurs when multiple images, or ghost images, are visible. Ghosting may present itself both, at daytime as well as at night.

Blurry vision, that manifests itself like “out of focus″ vision in all lighting conditions, often will appear more severely in dim light. Sometimes, images will only smear in a preferential direction.

A loss of contrast sensitivity, also linked to LASIK SMILE and due to the interface created by the lenticulebetween the flap and the stroma, is also proven. Contrast sensitivity is the ability to distinguish clearly details of an object between its light and dark portions. Contrast sensitivity, therefore, is especially important in dim light or fog conditions, when the contrast between objects and their background often is reduced already. Night driving is one activity where poor contrast sensitivity may impair safety. (16) (20)

Eyes are masterpieces, set them free!

If you landed on this website, maybe you are considering refractive surgery.
Certainly, we all appreciate the freedom of a life without glasses and contact lenses, being free to enjoy with friends and family your free time and sport activities or improving your working condition.

This website will guide you to discover how refractive surgery can improve your lifestyle, to evaluate the surgical techniques available, and how to make the best and safest choice for your eyes.

Ivis Center

Ivis Center

The iVis Centers epitomisesophtalmic excellence, specialising in refractive and therapeutic surgery using the latest generation of excimer lasers. They are internationally present in Europe, Africa, Oceania and in Asia soon.

Every iVis Center exploits the diagnostic and surgical platform iVis Suite™ together with the exclusive cTen™the Italian cutting edge in refractive surgery; a truly customised, completely no-touch and minimally invasive solution to correct refractive disorders, among them first of all myopia, hyperopia and astigmatism.

To date the iVis Centers have a background of tens of thousands of successfully performed cases, providing true opportunity to dispose of eyeglasses and contact lens forever.

Each iVis Center is an independent reality, but all of them share the common worldwide project of excellence of iVis Technologies, the company leader in custom corneal refractive and therapeutic surgery, who conceived and manufactures the iVis Suite, granting constant and continuous technological update all over the world.

The iVis Centers’ refractive surgeons continuously share their own experiences by means of the iVerify digital platform, exchanging knowledge, experiences and best practices, actively contributing to the continuous progress of the iVis Suite and its surgical accuracy.

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