Optimal parameters to improve the interface quality of the flap bed in femtosecond laser-assisted laser in situ keratomileusis

Serrao, Sebastiano; Buratto, Lucio; Lombardo, Giuseppe; Santo, Maria P. De; Ducoli, Pietro; Lombardo, Marco

doi:10.1016/j.jcrs.2012.05.021

Cited by 29 publications

(24 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,7 The femtosecond laser is also desirable for both anterior and posterior lamellar keratoplasty because of its excellent control in cut depth. Shallow femtosecond laser cuts for LASIK flaps have improved with increasing laser pulse repetition rate, 5,8 which allows use of lower pulse energy 9 and narrower spot separation. The laser is now commonly used for LASIK and consistent with excellent visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

Interface quality of different corneal lamellar–cut depths for femtosecond laser–assisted lamellar anterior keratoplasty

Zhang

Bald

Tang

et al. 2015

Journal of Cataract and Refractive Surgery

View full text Add to dashboard Cite

PURPOSE To evaluate interface quality of different corneal lamellar–cut depths with the femtosecond laser and determine a feasible range of depth for femtosecond laser–assisted lamellar anterior keratoplasty. SETTING Casey Eye Institute, Portland, Oregon, USA. DESIGN Experimental study. METHODS Full lamellar cuts were made on 20 deepithelialized human cadaver corneas using the femtosecond laser. The cut depth was 17% to 21% (100 μm), 31%, 35%, 38% to 40%, and 45% to 48% of the central stromal thickness. Scanning electron microscopy images of cap and bed surfaces were subjectively graded for ridge and roughness using a scale of 1 to 5 (1 = best). The graft–host match was evaluated by photography and optical coherence tomography in a simulated procedure. RESULTS The ridge score was correlated with the cut depth (P = .0078, R = 0.58) and better correlated with the percentage cut depth (P = .00024, R = 0.73). The shallowest cuts had the least ridges (score 1.25). The 31% cut depth produced significantly less ridges (score 2.15) than deeper cuts. The roughness score ranged from 2.19 to 3.08 for various depths. A simulated procedure using a 100 μm host cut and a 177 μm (31%) graft had a smooth interface and flush anterior junction using an inverted side-cut design. CONCLUSIONS The femtosecond laser produced more ridges in deeper lamellar cuts. A depth setting of 31% stromal thickness might produce adequate surface quality for femtosecond laser–assisted lamellar anterior keratoplasty. The inverted side-cut design produced good edge apposition even when the graft was thicker than the host lamellar–cut depth.

show abstract

Section: Discussionmentioning

confidence: 99%

Interface quality of different corneal lamellar–cut depths for femtosecond laser–assisted lamellar anterior keratoplasty

Zhang

Bald

Tang

et al. 2015

Journal of Cataract and Refractive Surgery

View full text Add to dashboard Cite

show abstract

“…There are large differences between femtosecond laser devices (Table 4), in terms of spot size, frequency, and energy which will affect smoothness and safety. Depending on the report, outcomes on smoothness vary in favor of FL 13,14,21 or MK, 5,11,22 but FL devices with lower energy and small Figure 2. Objective assessments of SEM images.…”

Section: Discussionmentioning

confidence: 99%

“…To date there have been a number of articles investigating this. [6][7][8][9][10][11][12][13][14][15] Several authors have developed subjective (observer based grading) and objective (e.g. texture analysis) scores to quantify the smoothness of stromal beds using primarily scanning electron microscopy (SEM) images for comparison.…”

Section: Scanning Electronic Microscopy Evaluation Of the Roughness Omentioning

confidence: 99%

Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria)

Varga

Bergin

Roy³

et al. 2016

Current Eye Research

View full text Add to dashboard Cite

Purpose: To compare the stromal bed surface quality and the accuracy of dissection depth after deep lamellar cuts using the Leonardo Da Vinci (LDV) femtosecond laser (Z6) and the ONE Microkeratome. Methods: Deep lamellar cuts were performed on nine human donor corneoscleral buttons: five with the LDV femtosecond (FS) laser (Z6) (Ziemer) and four with the ONE Microkeratome (MK) (Moria). Corneal thickness was measured with ultrasound pachymetry before and after the dissection. The Stromal bed quality was evaluated using light microscopy (n = 4) and scanning electron microscopy (SEM) (n = 9). The surface roughness on SEM images was graded on the scale of 1 (smoothest) to 5 (roughest) by four observers, blinded to the method used. Particle analysis on the SEM images was performed in order to have an objective measure of smoothness. Results: The achieved dissection depth using the FS laser was 496.4 ± 46.4 µm when attempting 500 µm and 474 ± 60 µm with the microkeratome when attempting 350 µm. Histological evaluation of the corneoscleral buttons by both light and electron microscopy showed significantly smoother surface using the FS laser compared to the microkeratome. There were fewer and smaller particles observed in the SEM images of FS laser cut buttons (p < 0.001).The average observer based score of anterior surface roughness (50×) was 2.2 for the FS laser and 3.9 for the microkeratome dissections (p < 0.001). Conclusions: The LDV femtosecond laser (Z6) platform is capable of creating deep corneal lamellar dissection with smoother surface quality and with more predictable cut depth as compared to the One Microkeratome.ARTICLE HISTORY

show abstract

“…It is known from histopathologic and confocal studies that higher frequency, lower energy pulses cause less tissue necrosis and render a smoother stromal bed compared to lower frequency, higher energy pulses 2,12. Thus, at least in theory, one could reasonably postulate that the iFS 150 kHz system might improve visual outcomes after LASIK.…”

Section: Discussionmentioning

confidence: 99%

Comparison of self-reported quality of vision outcomes after myopic LASIK with two femtosecond lasers: a prospective, eye-to-eye study

Sáles

Manche²

2016

OPTH

View full text Add to dashboard Cite

PurposeTo compare self-reported quality of vision (QoV) outcomes after myopic LASIK (laser-assisted in situ keratomileusis) with two femtosecond lasers.DesignProspective, randomized, eye-to-eye study.MethodsConsecutive myopic patients were treated with wavefront-guided LASIK bilaterally. Eyes were randomized according to ocular dominance. The flap of one eye was made with the IntraLase FS 60 kHz femtosecond laser with a conventional 70° side-cut, and the flap of the fellow eye was made with the IntraLase iFS 150 kHz femtosecond laser with an inverted 130° side-cut. Patients completed the validated, Rasch-tested, linear-scaled 30-item QoV questionnaire preoperatively and at Months 1, 3, 6, and 12.ResultsThe study enrolled 120 fellow eyes in 60 patients. None of the measured QoV parameters exhibited statistically significant differences between the groups preoperatively or at any postoperative time point.ConclusionCreating LASIK flaps with an inverted side-cut using a 150 kHz femtosecond laser and with a conventional 70° side-cut using a 60 kHz femtosecond laser resulted in no significant differences in self-reported QoV assessed by the QoV questionnaire.

show abstract

Optimal parameters to improve the interface quality of the flap bed in femtosecond laser-assisted laser in situ keratomileusis

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 29 publications

References 28 publications

Interface quality of different corneal lamellar–cut depths for femtosecond laser–assisted lamellar anterior keratoplasty

Interface quality of different corneal lamellar–cut depths for femtosecond laser–assisted lamellar anterior keratoplasty

Scanning Electronic Microscopy Evaluation of the Roughness of the Stromal Bed After Deep Corneal Cut with the LDV Femtosecond Laser (Z6) (Ziemer) and the ONE Microkeratome (Moria)

Comparison of self-reported quality of vision outcomes after myopic LASIK with two femtosecond lasers: a prospective, eye-to-eye study

Contact Info

Product

Resources

About