Femtosecond Lasers for LASIK Flap Creation

Farjo, Ayad A.; Sugar, Alan; Schallhorn, Steven C.; Majmudar, Parag A.; Tanzer, David J.; Trattler, William; Cason, John B.; Donaldson, Kendall E.; Kymionis, George D.

doi:10.1016/j.ophtha.2012.08.013

Cited by 135 publications

(55 citation statements)

References 77 publications

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“…Although the 100 μm cut depth was slightly smoother than deeper cuts, the difference was not statistically significant. Because the 100 μm cut depth is similar to a common LASIK setting, which produces excellent visual outcomes, 29 it is likely that the microscopic smoothness of deeper lamellar cuts is also compatible with good visual outcomes. However, the uniformity in microscopic roughness between different cut depths could also be attributed to the small sample size.…”

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

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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.

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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

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“…It is evidenced that femtosecond laser-assisted in situ keratomileusis (LASIK) is an established, effective, and safe technique used to treat myopia and myopic astigmatism 1–9. The creation of a flap thickness ranging from 100 to 130 μm with a standard deviation of 10–15 μm using femtosecond lasers is considered state of the art 2,3,7.…”

Section: Introductionmentioning

confidence: 99%

Comparison of efficacy, safety, and predictability of laser in situ keratomileusis using two laser suites

Meidani

Tzavara

2016

OPTH

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PurposeThe main aim of this study was to compare the efficacy, safety, and predictability of femtosecond laser-assisted in situ keratomileusis performed by two different laser suites in the treatment of myopia for up to 6 months.MethodsIn this two-site retrospective nonrandomized study, myopic eyes that underwent laser-assisted in situ keratomileusis using IntraLase FS 60 kHz formed group 1 and those using WaveLight FS200 femtosecond laser system formed group 2. Ablation was performed with Visx Star S4 IR and WaveLight EX500 Excimer lasers, respectively, in groups 1 and 2. Both groups were well matched for age, sex, and mean level of preoperative refractive spherical equivalent (MRSE). Uncorrected distance visual acuity, corrected distance visual acuity, and MRSE were evaluated preoperatively and at 1 week, 1 month, and 6 months after treatment.ResultsFifty-six eyes of 28 patients were included in the study. At 6-month follow-up postop, 78.6% of eyes in group 1 and 92.8% of eyes in group 2 achieved an uncorrected distance visual acuity of 20/20 or better (P=0.252). 35.7% and 50% in group 1 and group 2, respectively, gained one line (P=0.179). No eye lost lines of corrected distance visual acuity. Twenty-five eyes in group 1 (92.7%) and 27 eyes in group 2 (96.3%) had MRSE within ±0.5 D in the 6-month follow-up (P>0.999). The mean efficacy index at 6 months was similar in group 1 and group 2 (mean 1.10±0.12 [standard deviation] vs 1.10±0.1) (P=0.799). The mean safety index was similar in group 1 and group 2 (mean 1.10±0.10 [standard deviation] vs 1.10±0.09) (P=0.407). Conclusion: The outcomes were excellent between the two laser suites. There were no significant differences at 6-month follow-up postop between the two laser systems.

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“…Comparison studies are still being conducted comparing laser devices and mechanical microkeratomes. The laser devices have been found to be as good as or better than mechanical microkeratomes, but long-term results are still needed 3. Therefore, refinement of cutting quality with regard to morphology of cutting surfaces and edges is ongoing.…”

Section: Introductionmentioning

confidence: 99%

Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis

Heichel¹,

Wilhelm²,

Kunert³

et al. 2013

OPTH

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PurposeFemtosecond lasers have become the standard for laser-assisted in situ keratomileusis (LASIK) flap creation, but advanced mechanical microkeratomes are still an alternative, more cost-effective way to create the flap. The SCHWIND Carriazo-Pendular microkeratome is one of the most commonly used microkeratomes. The influence of different cutting parameters (head-advance speeds, cutting heads) on morphology of LASIK cuts was investigated.SettingExperimental study performed at the University Eye Hospital of the Martin Luther University Halle/Wittenberg, Halle (Saale), Germany.MethodsThe Carriazo-Pendular microkeratome was used on freshly enucleated porcine eyes for lamellar keratotomy. After flap removal, the cutting edge and stromal bed were evaluated from scanning electron micrographs using an individualized scoring system. Four different settings of microkeratome parameters were compared. For each setting, eight cuts were evaluated (n=32).ResultsDifferent oscillation frequencies and head-advance speeds did not influence the cutting qualities. A higher oscillation/feed rate ratio seemed to be advantageous for a smoother interface. Concerning different cuttings heads, a deeper keratotomy led to sharper cutting edges. The thinner the flap, the more irregularities in the stromal bed appeared. Complications did not occur.ConclusionThe Carriazo-Pendular microkeratome is a safe tool with which to create a LASIK flap and is a good alternative to a costly femtosecond laser. Deeper keratotomies, as well as the use of a higher oscillation/feed rate quotient, improve the cutting quality.

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Femtosecond Lasers for LASIK Flap Creation

Cited by 135 publications

References 77 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

Comparison of efficacy, safety, and predictability of laser in situ keratomileusis using two laser suites

Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis

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Femtosecond Lasers for LASIK Flap Creation

Cited by 135 publications

References 77 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

Comparison of efficacy, safety, and predictability of&nbsp;laser in situ keratomileusis&nbsp;using two laser suites

Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis

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Comparison of efficacy, safety, and predictability of laser in situ keratomileusis using two laser suites