Blade source effect on laser in situ keratomileusis flap thickness with the Amadeus I microkeratome

Ruth, Adrienne L.; Lynn, Michael; Randleman, J. Bradley; Stulting, R. Doyle

doi:10.1016/j.jcrs.2007.11.020

Cited by 11 publications

(6 citation statements)

References 18 publications

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“…Based on previous studies from our group regarding this microkeratome and blade combination, 16, 17 we anticipated the flap thickness to be 107 ± 12 µm, which is essentially identical to the results presented herein, and our reported range of central thicknesses (60 microns as measured with ultrasound pachymetry, 40 microns as measured with OCT) falls well within the reported ranges for femtosecond flaps.…”

Section: Discussionsupporting

confidence: 89%

Analysis of Microkeratome Thin Flap Architecture Using Fourier-domain Optical Coherence Tomography

Rocha¹,

Randleman²,

Stulting³

2011

J Refract Surg

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Purpose To assess the corneal architecture and reproducibility of laser in situ keratomileusis (LASIK) flap thickness created by the Amadeus II mechanical microkeratome using Fourier domain optical coherence tomography (OCT). Methods Anterior segment Fourier domain OCT (Optovue RTVue-100, Optovue Inc, Fremont, CA) was used to analyze the morphology of 58 LASIK flaps created with the Amadeus II microkeratome 140µm head (Ziemer Ophthalmic Systems AG, Port, Switzerland), with the ML7090CLB blade (Med-Logics, Inc, Laguna Hills, CA), at 2 weeks postoperatively. Flap thickness was assessed at 10 points across the central 6mm of the cornea (horizontal and vertical meridians). The postoperative central corneal flap thickness measured by Fourier domain OCT was compared with intraoperative ultrasound (US) pachymetry measurements. Results There was no significant difference between central flap thickness measured by intraoperative pachymetry (107.2±14µm) and postoperative OCT (111.7±11µm; p=0.07, correlation coefficient=0.86). Fourier domain OCT measurements demonstrated functionally planar flap architecture (SD of thickness across the flap= 4.9µm, SD range across the flap= 2 to 9 µm) for the microkeratome flaps. Conclusions The Amadeus II microkeratome with Med-Logics blades created thin, reproducible, functionally planar flaps as measured by the Fourier domain OCT. Central flap thickness measured by intraoperative US pachymetry was equivalent to that measured 2 weeks postoperatively by OCT.

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Section: Discussionsupporting

confidence: 89%

Analysis of Microkeratome Thin Flap Architecture Using Fourier-domain Optical Coherence Tomography

Rocha¹,

Randleman²,

Stulting³

2011

J Refract Surg

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“…After that date, the refractive surgery center switched to the ML7090 CLB blade (Med-Logics, Inc.) for comparative evaluation. A previous study 13 found that flaps created with the Amadeus I microkeratome were thinner and had less variance when an ML7090 CLB blade (blade A) was used than when a Surepass blade (blade B) was used.…”

Section: Methodsmentioning

confidence: 93%

“…A previous study 13 found that flap thickness with this mechanical micro-keratome varied depending on the blade used.…”

mentioning

confidence: 80%

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Influence of flap thickness on visual and refractive outcomes after laser in situ keratomileusis performed with a mechanical keratome

Bansal

Doherty

Randleman

et al. 2010

Journal of Cataract and Refractive Surgery

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PURPOSE To study the effect of flap thickness on visual acuity and refractive outcomes after laser in situ keratomileusis (LASIK) using 2 blade types with a mechanical microkeratome. SETTING Emory Vision, Atlanta, Georgia, USA. METHODS This retrospective analysis was of LASIK cases performed between January 2005 and June 2006 using an Amadeus I microkeratome and an ML7090 CLB blade (blade A) or a Surepass blade (blade B). Outcomes analyzed included flap thickness, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), the enhancement rate, and surgical complications 3 months postoperatively. RESULTS Two hundred sixty-three eyes of 153 patients were analyzed; blade A was used in 158 eyes and blade B, in 105 eyes. The mean flap thickness was significantly thinner with blade A than with blade B (107 μm ± 12 [SD] versus 130 ± 20 μm) (P<.0001). There was no overall correlation with either blade between flap thickness and UDVA, CDVA, or MRSE (all r<0.2). At 3 months, there was no statistically significant difference in UDVA, CDVA, or MRSE between the 2 blade groups at 3 months (all P > .10), and there was no difference in the complication rates. CONCLUSION Flap thickness did not affect visual or refractive outcomes with a mechanical micro-keratome with either blade type. FINANCIAL DISCLAIMER No author has a financial or proprietary interest in any material or method mentioned.

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“…Although femtosecond lasers and modern microkeratomes create thinner flaps with improved predictability 10, 18–22 thicker than expected flaps can still occur with any device. 22 Therefore, we recommend using average flap thickness plus 2 standard deviations for preoperative planning of residual stromal bed thickness and diligence with measuring flap thicknesses, especially in cases with potentially borderline RSB.…”

Section: Discussionmentioning

confidence: 99%

Flap thickness in eyes with ectasia after laser in situ keratomileusis

Randleman¹,

Hebson²,

Larson³

2012

Journal of Cataract and Refractive Surgery

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Purpose To measure central flap thickness in eyes with ectasia after LASIK and to compare these values with estimated anticipated flap thickness based on average published values for each device used for flap creation. Setting Emory Vision at Emory University, Atlanta GA, USA Methods Confocal microscopic analysis using the Confoscan 3 (Nidek technologies) to measure central flap thickness in eyes with ectasia after LASIK, and evaluation of pre-LASIK records, including basic patient demographics, preoperative corneal topographies, estimated anticipated flap thickness based on published average thickness values, and residual stromal bed thickness (RSB) calculations using both measured and estimated flap thicknesses. Results Fifty eyes from 29 patients were evaluated. Average measured flap thickness was (138 ± 26 μ, range 90 to 220 μ). There were no significant differences between measured and estimated flap thicknesses (138 vs. 135 μ, p = 0.5) or RSB (329 vs. 332 μ, p = 0.7), nor were there any differences in flap thickness between eyes with normal or abnormal corneal topographies. Only one eye had a measured flap resulting in unintended RSB < 250 microns; this occurred in an eye with abnormal topography. Conclusions Measured central flap thickness was not thicker than estimated for the vast majority of eyes developing ectasia after LASIK. Thus, excessively thick flaps do not appear to be a major contributing factor to the pathogenesis of ectasia after LASIK.

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Blade source effect on laser in situ keratomileusis flap thickness with the Amadeus I microkeratome

Cited by 11 publications

References 18 publications

Analysis of Microkeratome Thin Flap Architecture Using Fourier-domain Optical Coherence Tomography

Analysis of Microkeratome Thin Flap Architecture Using Fourier-domain Optical Coherence Tomography

Influence of flap thickness on visual and refractive outcomes after laser in situ keratomileusis performed with a mechanical keratome

Flap thickness in eyes with ectasia after laser in situ keratomileusis

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