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Femtosecond thin-flap SBK speeds return of visual function, normal activity
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SAN FRANCISCO — A femtosecond laser safely, effectively and accurately creates thin flaps of 90 µm or less for sub-Bowman's keratomileusis, a physician said here.
 Charles R. Moore |
Charles R. Moore, MD, shared his experiences using the Ziemer LDV femtosecond laser and 90-µm InterShield spacer at the American Society of Cataract and Refractive Surgery meeting.
"The LDV is a proven platform," he said. "It offers rapid visual recovery, less patient discomfort. It can be serviced online overnight, between surgery days. ... The quality with these flaps is absolutely excellent."
A prospective study included 244 consecutive SBK procedures. The patient group comprised 45% hyperopes and 55% myopes. Flaps thickness ranged from 400 µm to 700 µm. Ablation zones were 9 mm and 9.5 mm.
At 1 month postop, the 9.5-mm ablation zone yielded significantly higher best corrected visual acuity on average than the 9-mm zone. Visual function was restored rapidly, with patients able to drive 4 hours postop, Dr. Moore said.
Results showed few complications; the most common complication was decentered flaps. Vertical ridges occurred in about 10% of cases. There were three flap tears.
"I want to remind you that these are very thin planar flaps," Dr. Moore said. "They're just as thin at the periphery as they are in the center. When we're dealing with 90 µm, we have to be very delicate when lifting the flap."
Three cases required enhancements, Dr. Moore said.
Femtosecond flap generation for LASIK now represents more than 50% of cases performed in the United States. In a study performed at our center, my associate Elizabeth A. Davis, MD, FACS, and I also confirmed a more rapid visual rehabilitation for IntraLase thin flap LASIK when compared to microkeratome-generated flaps. In addition, we found a lower complication rate and a lower enhancement rate. We have not found a difference in outcomes with the IntraLase femtosecond laser combined with the VISX CustomVue excimer when using flap diameters between 8 mm to 9.5 mm in diameter. The finding in this study that 9.5 mm diameter flaps generated better outcomes than 9 mm diameter flaps is unexpected, and may actually be explained by the excimer laser, rather than the femtosecond laser. Multiple new femtosecond lasers are entering the marketplace, and these lasers are now being applied to intracorneal refractive surgery, corneal transplants and even cataract surgery.
– Richard L. Lindstrom, MD
OSN Chief Medical Editor