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PURPOSE: To analyze the quality of LASIK flaps created using a femtosecond laser or a mechanical microkeratome. METHODS: A prospective study of consecutive bilateral LASIK flaps (100 patients) created with a 15 kHz femtosecond laser (IntraLase) or with a mechanical microkeratome (Moria M2) was performed. Outcome measures included visual and refractive outcomes, flap dimensions, and intraoperative complications. The first consecutive ten patients (20 eyes) were examined using confocal microscopy 1 and 3 months following surgery. RESULTS: No significant differences were noted in the visual outcomes between groups (t test, P>.05 for all comparisons). Analysis of superficial measurements revealed more round flaps and greater predictability in surface dimensions for the femtosecond laser group (ttest, P=. 016). Mean deviation of flap thickness from target was the same for both instruments, 10 µm, with greater variability for the mechanical microkeratome. The incidence of diffuse lamellar keratitis was significantly greater in the femtosecond laser group (17%) than in the mechanical group (0%) (chi-square test, P<.001). Confocal microscopy revealed a higher wound healing opacity index in the femtosecond laser group. CONCLUSIONS: Although the clinical results are similar, the femtosecond laser produces LASIK flaps with more accurate dimensions compared to the mechanical microkeratome. [J Refract Surg. 2007;23:178-187.]

PURPOSE: To evaluate the visual and refractive stability and the potential long-term risks associated with ZB5M phakic intraocular lens (PIOL) implantation. METHODS: A retrospective, non-randomized, cumulative clinical study was performed over 12 years in a consecutive group of 225 eyes implanted with the ZB5M PIOL. The main analyzed variables were visual and refractive outcomes (best spectacle-corrected visual acuity [BSCVA], uncorrected visual acuity [UCVA], and spherical equivalent), endothelial cell density, and postoperative complications. RESULTS: Mean preoperative spherical equivalent refraction was -17.23±7.69 diopters (D) and 12 years postoperatively it was -1.80+0.80 D. Mean BSCVA at 1- and 12-year follow-up was 0.38±0.19 and 0.57+0.18, respectively (Wilcoxon test, P<.001). At 12 years postoperatively, 3.5% of eyes lost 3*2 lines of BSCVA. An initial 10.6% reduction in endothelial cell density was noted in the first year, followed by a mean annual rate of decrease of 1.78%. The cumulative incidence of pupil ovalization was 34.7% (78 eyes), and there was no statistical correlation with endothelial cell impairment. Bilateral hypertensive uveitis was diagnosed in 3 (1.33%) eyes. CONCLUSIONS: The ZB5M PIOL offers good refractive outcomes and stability in the long-term; however, endothelial cell loss increases over 12 years, requiring annual endothelial cell counts. [J Refract Surg. 2007;23:147-158.]

This technique of four-point scleral fixation of posterior chamber IOLs reduces the operation time, achieves good centration and stability of the IOL, and minimises postoperative suture-related complications.