This surgery is mainly aimed at a young, healthy and Figure 1: Mechanical corneal de-epithelialization. potentially numerous population; myopia affects 10 to 15% of the French population, and 50,000 people in1 the armed forces. It is estimated that there are 200,000 refractive laser surgery procedures carried out every year in France. In the armed forces2, 3and particularly for paratroopers, refractive surgery makes it possible to overcome the restrictions of glasses or contact lenses that can hinder the soldier in carrying out their mission. It is not uncommon for the jumper to lose their glasses during a jump.79% of parachutists have reported losing their glasses in freefall on at least one occasion.4 The loss of glasses has a negative impact on mission success on the ground in 7.3% of jumps. The absence4 of glasses also aids the wearing of protection systems and sighting devices. Side effects or complications from refractive surgery may, for some military personneloperated on, be a cause of unfitness for their specialist field. TYPES OF REFRACTIVE SURGERIES Figure 2: Laser treatment. There should be a distinction made between corneal refractive surgery that is predominantly carried out using a laser and intraocular refractive surgery that requires an intraocular lens. 1. Corneal Ablation Laser Refractive Surgeries This represents the majority of the refractive surgeries at present. Corneal ablation procedures make it possible for most ametropia to be corrected and are therefore aimed at the largest number of people. Myopia can be corrected up to -10D, hypermetropia up to + 6D and astigmatism up to 4D. This means carrying out a photoablation of the corneal stroma (PRK, LASIK) or a small incision lenticule extraction (SMILE) and reshaping the curvature of the cornea5-8. The main complications common to these treatments arepatients present varying degrees of eye pain and pho- infection, inflammatory reactions (corneal haze, diffusetophobia. In order to reduce eye pain, a soft hydrophi- interstitial keratitis) or corneal ectasia.It is estimated lic contact lens is placed for the first three days (fig. 3). that 1 to 2% of refractive surgeries have post-operative Visualacuity returns progressively over the course of complications. several days. Resumption of activities is often possible 5 to 7 days after the operation. Visual acuity is generally The side-effects of these treatments are most oftenstable a month after the operation, but this could be temporary: dry eyes, excessive glare, night-time halosup to 3 or even 6 months in certain patients. and a reduction in contrast perception. ∑Ophthalmology Dept., 1.1. PRK (Photorefractive Keratectomy) HIA Percy, Clamart, France. •Surgical procedure ∏CPEMPN, Clamart, France. Access to the anterior corneal stroma is possible after πOphthalmology Dept.,HIA Bégin, Saint-Mandé, France. mechanical de-epithelialization (fig. 1), generally assis- ted beforehand by applying alcohol. The photoablation ∫Ecole du Val-de-Grâce, Paris, France. of the cornealstroma is then carried out by Excimer Correspondence: laser (acronym for Excited Dimer); a pulsed laser emitting Chief Physician M. DELBARRE Ophthalmology Dept., ultraviolet rays that vaporises the cornealtissue by HIA Percy, rupture of the intermolecular links (fig. 2). B.P. 406, 92141 Clamart Cedex, France E-mail: maxime.delbarre@intradef.gouv.fr •Recovery time and side effects *With courtesy of Editor of Mécecine et Armé VOL. es. In the first days of healing of the corneal epithelium, Published in French in Médecine et Armées 2019, 47, 2, 123-132. 94/3 International Review of the Armed Forces Medical Services 41 Revue Internationale des Services de Santé des Forces Armées