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Sub-Bowman's flap may be preferable in LASIK, laser expert says
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LONDON — Thin LASIK flaps may preserve corneal stability without the induction of postoperative corneal haze or pain after refractive surgery, a laser expert speaking here suggested.
John Marshall, PhD, of St. Thomas' Hospital in London, discussed his recent work analyzing corneal biomechanics in a keynote lecture during a session on femtosecond lasers at the European Society of Cataract and Refractive Surgeons meeting.
Corneal surface wounds, such as those created during PRK, disrupt Bowman's layer and weaken the cornea, in addition to causing postoperative pain for the patient, Prof. Marshall said. Deep-cut microkeratome flaps, if they leave a stromal bed that is too shallow, can also weaken the cornea in LASIK. But LASIK flaps cause little of the wound healing response and cellular reaction seen with surface ablation, he noted.
A thin flap, just posterior to Bowman's membrane, created with the IntraLase FS femtosecond laser, may be the best way to avoid the problems with other approaches to corneal refractive surgery, Prof. Marshall suggested.
"I am intrigued by the ability of IntraLase to cut shallow flaps," he said. "With a 90-µm flap, Bowman's is intact and the epithelium is beautiful. When we lift the membrane, we don't disturb cells, we don't induce a wound healing reaction, and thus we preserve the biomechanics of the cornea."
Prof. Marshall advised surgeons in the audience to think about using sub-Bowman's membrane flaps in future refractive procedures.