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Second microkeratome motor adds safety, consistency to LASIK, study suggests

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Microkeratomes with a second motor for blade advancement offer better flap consistency than microkeratomes with a single motor, a retrospective study concluded.

In a study reviewing results with four microkeratome designs, the Moria M2 and the Alcon SKBM provided the best predictability and reproducibility of flap thickness. The study authors attributed the better consistency to the use of a second motor for advancement of the blade.

Danielle Miranda, MD, and colleagues with the Cole Eye Institute in Cleveland, Ohio, evaluated 490 consecutive eyes that underwent LASIK during a 1-year period. All flaps were created using one of four microkeratomes: 41 with the Bausch & Lomb Hansatome 180, 127 with the Alcon SKBM, 65 with the Moria CB 130 and 257 with the Moria M2. All patients underwent laser ablation with the Alcon LADARVision 4000. Bilateral LASIK was performed in 226 patients and unilateral LASIK in 38.

Microkeratome type was selected based on the patient’s preoperative keratometry and pachymetry, the availability of the device and otherwise random choice.

Average patient age was 43; 442 eyes were myopic, with a range of –0.5 D to –12.5 D and cylinder up to 3.25 D. The remaining eyes were hyperopic, with a mean refraction of +2.1 D and cylinder up to 2.5 D.

Flap thickness measurements varied considerably according to the microkeratome used. The mean measurement with the Hansatome was 131 µm, with the SKBM 162 µm, with the Moria CB 157 µm and with the Moria M2 134 µm.

Central flap thickness was consistently more reproducible with the SKBM and the Moria M2 than with the Moria CB (P < .0005), the authors reported. No correlation was found between flap thickness reproducibility and age, corneal thickness or corneal keratometric values.

“If the flap thickness in the [first] eye is 100 µm or less, the blade should be changed before making a flap in the [contralateral] eye,” the authors suggested in the October issue of Ophthalmology.

The greater variability noticed with the Moria CB was “most likely due to the manual translation feature and places further importance on the second motor and automation when performing LASIK,” the authors said. “From our results, we can infer improved safety and predictability in creating LASIK flaps with a dual motor microkeratome.”