Laser in situ keratomileusis flap-thickness predictability with a pendular microkeratome

Paschalis, Eleftherios I.; Labiris, Georgios; Aristeidou, Antonis; Foudoulakis, Nikitas C.; Koukoula, Stavrenia; Kozobolis, Vassilios

doi:10.1016/j.jcrs.2011.05.044

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…11,12 Current mechanical microkeratomes create LASIK flaps with an SD of approximately 22 to 26 mm. 9,6,13,14 In this study, flap thickness was found to have excellent predictability with a lower SD (13.9 mm) for flap- thickness variability compared with that generally achieved by mechanical microkeratomes. In addition, consecutive patients who had LASIK for myopia, hyperopia, and mixed astigmatism with flaps made using this new femtosecond laser had good, predictable, and stable outcomes.…”

Section: Discussionmentioning

confidence: 52%

Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser

Cummings¹,

Cummings²,

Kelly³

2013

Journal of Cataract and Refractive Surgery

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Section: Discussionmentioning

confidence: 52%

Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser

Cummings¹,

Cummings²,

Kelly³

2013

Journal of Cataract and Refractive Surgery

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“…In both studies,13,14 the precision was found to be at least 0.15 mm, which is a very large standard deviation and more uncertain than the corresponding FS200-created flaps, as measured by our digital technique.…”

Section: Discussionmentioning

confidence: 58%

“…Thus, we introduce this novel technique as a new benchmark for evaluating flap dimensions in LASIK. In another recently published study that examined the predictability of dimensions for flaps created using a pendular microkeratome,13 it was found that the microkeratome achieved a mean flap diameter of 9.2 mm using the 9.0 mm ring and 9.8 mm using the 10.0 mm ring, indicating a precision in the order of 0.2 mm.…”

Section: Discussionmentioning

confidence: 98%

Digital analysis of flap parameter accuracy and objective assessment of opaque bubble layer in femtosecond laser-assisted LASIK: a novel technique

Kanellopoulos

Asimellis²

2013

OPTH

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Background:The purpose of this study was to determine flap parameter accuracy, extent of the opaque bubble layer, and incidence of skip lines in femtosecond laser-assisted stromal in situ keratomileusis (LASIK) using the WaveLight® FS200 laser and optoelectronic clinical measurements.Methods:Images from 101 flaps were automatically recorded during consecutive routine LASIK procedures performed using the WaveLight FS200 femtosecond laser and the EX500 excimer laser. Digital processing of these images was used to evaluate objectively the diameter of FS200-created flaps, by comparing planned versus achieved procedures and to evaluate the incidence and extent (area) of the opaque bubble layer.Results:The intended flap diameters were between 8.00 mm and 9.50 mm. The achieved flap diameters showed extremely high precision, and were on average −0.16 ± 0.04 mm smaller for a 8.00 mm intended flap diameter, −0.12 ± 0.03 mm smaller for a 8.50 mm flap, and up +0.06 ± 0.06 mm wider for a 9.50 mm flap. With an average flap area of 72.4 mm2, the mean area of the opaque bubble layer (4.1 ± 4.3 [range 0–14.34] mm2) corresponded to a 6% opaque bubble layer-to-flap area. Specifically, 80% of the femtosecond-created flaps had an essentially zero opaque bubble layer (<2.7% of the flap area).Conclusion:In our clinical experience, flaps created using FS200 and this novel highly objective assessment technique demonstrate both precision and reproducibility. The incidence of opaque bubble layer was minimal.

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“…The same conclusion is brought by Pallikaris [ 7 ], stating that corneal keratometric values are irrelevant to keratome complication risk in general or specifically to FF risk. Mitsutoshi et al [ 9 ] found in 0.14% FF incidence that neither flat and steep keratometries nor vertical and horizontal white-to-white corneal diameters were correlated to the incidence of flap complications in general or FF specifically. The last two studies did not use the SBK MK, but nevertheless, their conclusions also correspond to this study’s finding of keratometry not being related to FF incidence.…”

Section: Discussionmentioning

confidence: 99%

“…Mitsutoshi [ 9 ] also reported 25 (0.67%) flap complications in 3,751 LASIKs done by 10 young surgeons using five different MKs and not the SBK. Three of the flap complications (0.08% of all LASIKs) were FF and all happened only with a single model of the five MKs (LSK one by Moria, France).…”

Section: Discussionmentioning

confidence: 99%

Prediction model of free flaps in microkeratome-assisted LASIK

Katz

Druckiv²,

Siebelmann³

et al. 2021

PLoS ONE

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Purpose To identify mechanical factors, as well as patients’ biometric and surgeons’ experience factors that correlate with the FF incidence in microkeratome (MK)-assisted LASIK and to construct a predictive model based on these parameters. Methods 55,700 consecutive LASIK treatments of 28,506 patients between January 2017 and April 2020 done by 50 surgeons in 10 centers, all with Sub Bowman Keratome (SBK) and 90μ head (OUP) were analyzed retrospectively for the incidence of FF and their correlation to mean keratometry, central corneal thickness, MK ring height and stop, as well as surgeons’ experience. A prediction model was built and tested for sensitivity and specificity. Results The incidence of FF using the SBK MK was 0.276%. Risk factors were low central corneal thickness, very flat (-1) or very thick (+2) ring height, and higher stop values (p<0.001). Mean keratometry and low surgeon experience were not correlated to FF incidence. A prediction model with a cut-off FF risk of 0.274%, a 76% specificity, and a 73% sensitivity was applied. Conclusions Free flaps are rarely seen in modern MK LASIK. However, the incidence of this complication using the SBK MK increases using higher stop values, very thick and very thin MK rings, and in eyes with thin corneas.

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Laser in situ keratomileusis flap-thickness predictability with a pendular microkeratome

Cited by 10 publications

References 29 publications

Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser

Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser

Digital analysis of flap parameter accuracy and objective assessment of opaque bubble layer in femtosecond laser-assisted LASIK: a novel technique

Prediction model of free flaps in microkeratome-assisted LASIK

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