Femtosecond-guided LASIK enhancement has minimal trauma, reduced rate of epithelial ingrowth

José Güell

ROME — A new technique of LASIK enhancement using a femtosecond laser allows for easy flap re-lifting, minimal trauma and significantly reduced rate of epithelial ingrowth, according to one surgeon.

José Güell, MD, discussed the Visumax femtosecond laser (Carl Zeiss Meditec) at the meeting of the Italian Society of Cataract and Refractive Surgery.

"Re-LASIK with the manual technique of re-lifting the flap is associated with significant incidence of epithelial ingrowth, ranging between 2% and 20% of the cases," Dr. Güell said. "By using the femtosecond laser, I have had no case of epithelial ingrowth in 85 eyes."

Preoperatively, the thickness and diameter of the flap created by the mechanical microkeratome in the primary procedure is evaluated by anterior segment optical coherence tomography (Visante, Carl Zeiss Meditec).

These and other flap parameters, such as hinge position, are transferred to the Visumax laser.

Based on these data, the laser performs a circumferential, concentric vertical cut inside the original LASIK cut, 1.2 mm smaller and 10 µm thicker than the original one. Cut angle is usually 90°, hinge position is the same as in the original flap, and hinge angle is usually 50º.

Once the femtosecond laser has created the circumferential cut, the original flap interface is easily found.

"The femtosecond laser creates a smooth interface, with minimal trauma to the epithelium. The vertical cut also creates an ideal morphology to minimize epithelial cell migration," Dr. Güell said.

This new technique is likely to become the standard of LASIK enhancement, he said.

Disclosure: Dr. Güell is a consultant for Carl Zeiss Meditec.