BACKGROUND: Attachment of a keratomileusis lenticule without sutures is a commonly used technique that reduces surgery time and makes the procedure more simple. Detachment of the lenticule after surgery is a difficult complication to manage. PATIENTS AND METHODS: Three cases of lenticular detachment occurred among 74 eyes of microkeratome in situ keratomileusis without suture. After thorough washing of the lenticule and stromal bed, the lenticules were reattached with air drying. RESULTS: In the first eye, the lenticule was reattached successfully with air only. In the second and third eyes, epithelial growth along the interface appeared after reattachment. In spite of removing the epithelium from the interface and suturing the lenticule to the stromal bed four times, the epithelial growth recurred along the interface. Peripheral corneal neovascularization forced the surgeon to abandon more trials of resuturing. In the second eye, the lenticule was discarded because the epithelial growth along the interface could not be blocked. In the third eye, the edge of the lenticule was buried into the stroma, mimicking epikeratoplasty. All three eyes retained useful visual acuity. CONCLUSIONS: A detached lenticule after microkeratome keratomileusis is difficult to replace without epithelial growth in the interface. This complication may be managed successfully. [J Refract Surg. 1996;12:175-179.]

BACKGROUND: There are currently four techniques of keratomileusis in clinical use: cryolathe, planar with mold, excimer laser, and in situ. Comparative studies among the techniques are rare in human cadaver eyes. We studied the newest of these techniques using the argon fluoride (193 nm) excimer laser to perform the excision of stroma as compared to the nonfreeze, planar, lamellar myopic keratomileusis using the Barraquer- Krumeich-Swinger (BKS) technique. METHODS: Corneas were dehydrated in dextran-containing medium. A 9.00-diopter correction was attempted with each technique using the manufacturers' parameters. There were six eyes in each group. Keratometry was done with the instrument (Bausch & Lomb) mounted vertically. RESULTS: The laser group achieved a mean keratometric flattening of 5.80 ± 1 .00 D; the BKS group achieved a flattening of 3.80 ± 1 .30 D. CONCLUSIONS: These results demonstrated the difficulty in obtaining results in eye-bank eyes that match those achieved clinically. The different results of these two techniques underscore the need to use clinical data to adjust laser keratomileusis operating parameters. (Refracf Corneal Surg 1993;9:36-41.) RÉSUMÉ INTRODUCTION: Il y a maintenant quatre techniques de keratomileusis utilisées en clinique: le cryo-tour, le planaire avec forme, le laser excimer, et le "in situ." Les études comparatives de ces techniques sont rares chez les yeux de cadavres humaines. Nous avons étudiée la plus récente de ces techniques, le laser excimer à l'argon-fluoride (193 nm) afin de réaliser l'excision du stroma corneen, et nous l'avons comparé à la technique lamellaire et planaire du keratomileusis sans congélation selon Barraquer-KrumeichSwinger (BKS). METHODES: Les cornées furent déshydratées dans un véhicule contenant du dextran. Une correction de 9.00 dioptries fut tenté avec chaque technique, selon les critères des fabricants. Chacun des groupes étaient constitués de 6 yeux. Il y eut six yeux dans chaque groupe. La kératométrie fut accompli avec l'instrument monté à la vertical. RÉSULTATS: L'aplatissement kératométrique moyen du groupe traité au laser fut de 5.80 ± 1 .00 dioptrie et de 3.80 ± 1 .30 dioptries chez le groupe BKS. CONCLUSION: Cette étude démontre la difficulté d'obtenir des résultats similaires chez les yeux cadavériques, aux résultats cliniques observés. Les résultats différents de ce deux techniquess soulignent l'importance de l'utilisation de données cliniques en ajustant les paramétre opérationnels du laseï excimeî en keratomileusis. La technique ici présentée ne nécessite qu'une coupe de microkératome, et n'utilise pas le crytour. (Translated by Rob Mack, MD, Iowa City, Iowa) SOMMARIO PREMESSA: Attualmente vengono utilizzate 4 tecniche di cheratomileusi: mediante tornitura dopo congelamento del lembo, planare con microcheratomo, con laser ad eccìmeri, ed in situ. Studi comparativi tra le tecniche sono rari in occhi di cadavere umani. Noi abbiamo valutato la più attuale di queste tecniche, quella con laser ad eccimeri a fluoruro di argon (193 nm) per effettuare delle asportazioni dello stroma, paragonandola alla cherafomileusi miopica lamellare planare a fresco, utilizzando la tecnica dì Barraquer-Krumeich-Swinger (BKS).