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No complications seen with microkeratome ultra-thin flap LASIK
J Refract Surg. 2009;25(1):33-36.
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Ultra-thin flap LASIK with the Carriazo-Pendular microkeratome had increased flap creation accuracy and no intraoperative or postoperative complications.
A prospective study included 47 eyes of 26 myopic patients who had a mean age of 28.78 years. Patients underwent LASIK with a superior hinge flap created with the 90-µm head of the Schwind Carriazo-Pendular microkeratome.
Mean flap thickness was 79.88 µm, mean flap diameter was 9.25 mm, and mean hinge size was 4.63 mm.
Patients were examined 60 minutes, 1 and 3 days, and 1 month after surgery.
Uncorrected visual acuity improved significantly from counting fingers to 0.80 on postoperative day 1 and 0.95 on postoperative day 3. Mean UCVA was 0.99 at 1 month, and mean best corrected visual acuity was 1 at 1 month. No eyes lost lines of BCVA. All eyes were emmetropic within 1 D at 1 month.
"Future studies should include evaluation of anterior segment [optical coherence tomography] to characterize the uniformity and shape of the flaps, in addition to biomechanical studies to assess the viscoelasticity of the cornea after ultra-thin microkeratome flaps," the authors said.
The authors point out the limitations of this study in the discussion, in that it is a relatively small set of eyes, so the true incidence of buttonholes or incomplete flaps is impossible to tell from this set of patients, and large groups of patients will be needed to find out the actual incidence. Additionally, as they mention, analysis of regional thickness of the flaps will be important, as some flaps that are thin in the center may be thicker in the periphery. It is becoming clearer that the biomechanical stability of the cornea is greater with a thinner flap, especially in the mid-periphery, and so the configuration of these flaps is very important. Further information about the biomechanical stability of flaps with this and other keratomes will help us to provide greater safety with LASIK.
– David R. Hardten, MD
OSN Cornea/External Disease Board Member