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Epithelial ingrowth reduced with femtosecond laser-cut LASIK flaps

J Refract Surg. 2009;25(11):1039-1044.

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Laser-cut LASIK flaps may be less likely to develop epithelial ingrowth requiring re-treatment than flaps cut with a mechanical microkeratome, according to a study.

In a retrospective analysis of 272 consecutive LASIK re-treatments performed by a single surgeon over a 4-year period, a manual microkeratome was used to cut the initial flap in 132 eyes and a femtosecond laser was used in 140 eyes. Epithelial ingrowth was identified in 11 eyes of nine patients, and surgical intervention was required to remove the epithelium from the stromal interface in eight eyes. In the femtosecond group, epithelial ingrowth was noted in two eyes of one patient, but surgical intervention was not required.

Femtosecond laser may confer an advantage, the authors noted, because the laser cuts a nearly vertical flap as opposed to a tapered flap edge, which may facilitate epithelial ingrowth to the stroma, and because the laser cuts the flap via cavitation bubble as opposed to sliding across the stroma, "which increases the risk of inoculating the epithelium."