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Enhanced femtosecond laser model allows greater flap customization
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CHICAGO — The fifth-generation IntraLase femtosecond laser provides advantages over earlier models in flap design and strength, according to one surgeon speaking here.
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Perry S. Binder, MD, outlined the goals of LASIK surgery during the Richard L. Lindstrom Lecture at the American Society of Cataract and Refractive Surgery annual meeting. As a surgeon, Dr. Binder said he wants to be able to predict wavefront aberrations and flap thickness, eliminate flap complications, create a smooth stromal surface and have predictable refractive outcomes.
"I think that our laser accomplishes most of these goals better than any other currently existing technology while placing all the tools necessary for customizing the flaps in your hands," he said.
Compared with the fourth-generation model, the fifth-generation IntraLase femtosecond laser (Advanced Medical Optics) allows an elliptical flap and a side angle cut of up to 150°.
The elliptical flap prevents removal of peripheral corneal fibers, allows greater exposure of the stromal bed for full ablation and provides for the wider flap angle, which results in greater flap stability and preserves corneal nerves, Dr. Binder said.
In a study conducted by Arturo Chayet, MD, and colleagues, 20 patients underwent surgery with an elliptical flap cut in one eye and a circular flap cut in the other. They found statistically significant differences in defocus, higher-order root mean square wavefront error and spherical aberrations, Dr. Binder said.
In another study by Melvin A. Sarayba, MD, and colleagues, five masked investigators graded stromal surface quality. Stromal beds created with the fifth-generation model earned a 2.32 mean rating, while stromal beds created with the fourth-generation model had a 2.46 mean rating. Lower numbers indicated a smoother surface.
Additionally, Dr. Binder and colleagues conducted a prospective study looking at 30 patients who underwent surgery with the fifth-generation IntraLase. Specifically, one eye of each patient had a 70° angle cut and one eye had a 150° angle cut.
They found that 64% of eyes that received the 150° cut had greater flap adhesion strength at 10 weeks.
"This inward bevel is creating a tighter wound," Dr. Binder said.
Additionally, surgery with the new model is 2.5 times faster than with the fourth-generation IntraLase.