Laser-assisted in-situ keratomileusis (LASIK) with a mechanical microkeratome compared to LASIK with a femtosecond laser for LASIK in adults with myopia or myopic astigmatism

Kahuam-López, Nicolás; Navas, Alejandro; Castillo‐Salgado, Carlos; Graue-Hernández, Enrique O; Jiménez-Corona, Aída; Ibarra, Antonio

doi:10.1002/14651858.cd012946.pub2

Cited by 16 publications

(20 citation statements)

References 70 publications

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“…Laser in situ keratomileusis (LASIK) was first introduced by Pallikaris et al [ 1 ]. Since it was found to be highly effective and safe, resulting in a rapid vision recovery, and was associated with marginal patient discomfort, LASIK became the most common ophthalmic surgical procedure used worldwide [ 2 , 3 , 4 , 5 , 6 ]. Notably however, it involves a relatively long learning curve and is associated with the risk of flap-related complications such as free cap, incomplete flap, buttonholes, epithelial ingrowth, lost flaps, and deep lamellar keratitis [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population

Kim

Lee

Joo

et al. 2021

JPM

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This multi-center cohort study included 3401 myopic laser in situ keratomileusis (LASIK) procedures conducted in 1756 myopia patients between 2002 and 2005. Pre- and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction spherical equivalent (SE) were recorded. Factors predicting low postoperative efficacy (defined as a postoperative UCVA < 0.5) were identified using univariate and multivariate logistic regression analysis. Compared with 1 month postoperatively, logMAR UCVA at 3 months postoperatively was significantly decreased (p = 0.002) and that at 2 and 3 years was significantly increased (p < 0.001). LogMAR BCVA at 2 years postoperatively was significantly decreased compared with 1 month postoperatively (p = 0.008). Over the 3-year postoperative period, overall refractive predictability within ±1.00 D and ±0.50 D ranged from 69.0% to 86.2% and from 43.3% to 67.8%, respectively. This also decreased from 1 month to 6 months postoperatively (p < 0.005). Multivariate logistic regression analysis using generalized estimating equations, revealed that higher preoperative SE (odds ratio [OR], 2.58 and 7.23; p < 0.001) and lower preoperative BCVA (OR, 2.44; p = 0.003) were predictive of a low postoperative efficacy. In summary, myopic LASIK can be effective and safe with a high refractive predictability in a Korean population, but myopic regression occurs over time. Higher preoperative SE and lower preoperative BCVA are predictive of a low postoperative efficacy.

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Section: Introductionmentioning

confidence: 99%

Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population

Kim

Lee

Joo

et al. 2021

JPM

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“…The introduction of femtosecond lasers has significantly improved the safety and outcomes following refractive surgery. [ 6 7 8 9 ] Femtosecond lasers create flaps that are more precise, and tend to have a more uniform and predictable thickness, shape, and hinge width. However, corneal flaps weaken the cornea, besides introducing corneal aberrations in patients undergoing LASIK.…”

Section: Discussionmentioning

confidence: 99%

Elliptical versus circular flap configuration in myopic eyes undergoing femtosecond laser in situ keratomileusis surgery: A contralateral eye study

Gupta

Thakur²,

Gupta

et al. 2021

Indian J Ophthalmol

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Purpose: To study whether a customized elliptical flap configuration offers any visual, refractive, or biomechanical advantage over the “conventional” circular flaps in patients undergoing myopic laser in situ keratomileusis (LASIK). Methods: A prospective interventional contralateral eye study was undertaken enrolling 290 eyes of 145 myopic patients (≤−6.0D) undergoing LASIK, wherein the corneal flap was created in one eye using a customized elliptical flap configuration versus a conventional circular flap configuration in the other eye. Postoperatively, we compared the visual outcome, change in higher-order aberrations, corneal asphericity, and corneal biomechanics. Results: The visual outcomes, including higher-order aberrations, were comparable between the two groups. Changes in spherical aberration (mean: 0.234–0.331 versus 0.234–0.42; P = 0.644), corneal asphericity (−0.32–0.34 versus − 0.34–0.45; P = 0.42), corneal hysteresis (9.35–7.33 versus 9.4–6.71, P = 0.489), corneal resistance factor (9.71–7.40 versus 10.38–6.9, P = 0.181) were comparable between the elliptical and circular groups, respectively. Conclusion: We evaluated the usefulness of a customized elliptical flap configuration for performing LASIK surgery. Our data suggests that elliptical flaps may be associated with superior visual and biomechanical performance compared to circular flaps. This is certainly relevant in eyes with “borderline” pre-LASIK profile to improve patient satisfaction and safety after surgery.

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“…The IntraLase platform induces a lower IOP to increase during suction than the Moria MMK (119.33 ± 15.88 mm Hg vs. 160.52 ± 22.73 mm Hg, respectively), although the time needed for creating the flap was more than twice as long (92.85 ± 13.49 s vs. 36.42 ± 7.48 s, respectively) [70]. In newer platforms, suction times may be slightly shorter: Salomão et al reported it was 56 s for the 30 kHz platform, and 40 s for the 60 kHz laser [15]. The introduction of high repetition rate femtosecond lasers has decreased the time needed for flap creation [1,8,71].…”

Section: Risk Of Intraoperative Complications Associated With Flap Creationmentioning

confidence: 99%

“…A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (femtoLASIK) and LASIK using mechanical microkeratomes [ 15 ]. Flap-related complications comprise the majority of complications in LASIK both intraoperatively, and postoperatively [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis

Kanclerz

Khoramnia

2021

Diagnostics

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Introduction: A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (LASIK) and LASIK using mechanical microkeratomes (MMKs). This study compares the flap thickness and risk of complications related to flap creation using femtosecond lasers and MMKs. Methods: PubMed and the Web of Science are used to search the medical literature. An extensive search is performed to identify the flap thickness and complications of LASIK as reported up to Jul 15, 2021. The following keywords are used in various combinations: Corneal flap, femtosecond laser, laser in situ keratomileusis, laser-assisted in situ keratomileusis, LASIK, mechanical microkeratome. Results: After removing duplicates and irrelevant studies, 122 articles were included for review. Pooled differences for intended vs. postoperative flap thickness using MMKs and femtosecond laser were −4.07 μm (95% CI: −19.55, 3.24 μm) in studies on the MMK and 5.43 μm (95% CI: 2.30, 7.84 μm; p < 0.001), respectively. After removing the studies evaluating outcomes of the old generation Hansatome MMKs (which had a significantly greater variation of flap thickness), the pooled difference for newer MMKs was 4.97 μm (95% CI: 0.35, 9.58 μm; p < 0.001), but the results still favored the femtosecond laser. Uncommon and mild complications unique for the femtosecond LASIK are epithelial gas breakthrough, opaque bubble layer, transient light sensitivity syndrome, and rainbow glare. A single study reported a very low, but stastically different risk of postoperative flap slippage (0.033% for MMK LASIK, and 0.003% for femtosecond LASIK, respectively). Conclusion: In both manual microkeratome and femtosecond LASIK, intra- and postoperative complications were uncommon. The evidence of the superiority of one technique in terms of complications over another cannot be indisputably stated.

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Laser-assisted in-situ keratomileusis (LASIK) with a mechanical microkeratome compared to LASIK with a femtosecond laser for LASIK in adults with myopia or myopic astigmatism

Cited by 16 publications

References 70 publications

Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population

Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population

Elliptical versus circular flap configuration in myopic eyes undergoing femtosecond laser in situ keratomileusis surgery: A contralateral eye study

Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis

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