Microkeratome complications

Lee, Jimmy K.; Nkyekyer, Esi; Chuck, Roy S.

doi:10.1097/icu.0b013e32832bfbcb

Cited by 19 publications

(6 citation statements)

References 30 publications

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“…These include increased precision, a reduced incidence of flap complications, and the ability to cut thinner flaps without the risk for buttonhole formation. [1][2][3] Despite this overall success, the 2-step approach to flap cutting and subsequent excimer laser ablation can potentially be improved by using a less invasive technique known as femtosecond lenticule extraction (FLEx). Femtosecond lenticule extraction is a recently developed laser corneal refractive procedure based on the extraction of an intrastromal lenticule and can be performed with the Visumax femtosecond system only (Carl Zeiss Meditec AG).…”

Section: Resultsmentioning

confidence: 99%

Effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis

Zhang

Zhou

Zheng

et al. 2014

Journal of Cataract and Refractive Surgery

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Section: Resultsmentioning

confidence: 99%

Effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis

Zhang

Zhou

Zheng

et al. 2014

Journal of Cataract and Refractive Surgery

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“…The FS laser offers several advantages over manual microkeratomes including increased precision, reduced incidence of flap complications, and the ability to cut thinner flaps without the risk of buttonhole formation. 3,4 Moreover, newer generation FS lasers have reduced problems such as transient lightsensitivity syndrome and interference by cavitation bubbles. 5,6 In its current form, 'bladeless' LASIK requires the use of 2 lasers: the FS laser for flap creation and an excimer laser for ablative reshaping of the cornea.…”

mentioning

confidence: 99%

Femtosecond Lenticule Extraction (FLEx): Clinical Results, Interface Evaluation, and Intraocular Pressure Variation

Ang

Chaurasia

Angunawela

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To characterize the clinical profile of femtosecond lenticule extraction (FLEx) correlated with ultrastructural analysis of the corneal interface and in vivo real-time intraocular pressure (IOP). METHODS. Prospective clinical case series with experimental studies; consecutive patients underwent FLEx at a single tertiary center over 10 months with postsurgical follow-up of 3 months. The patients were divided into three groups according to spherical equivalence (SE) (A, Ͻ Ϫ5.0 diopters [D]; B, Ն Ϫ5.00 D and Ͻ Ϫ9.00 D; and C, Ն Ϫ9.0 D). Twelve human cadaveric eyes analyzed using scanning electron microscopy after receiving FLEx; 40 rabbit eyes received FLEx with in vivo IOP measurements. The main outcome measures were refractive outcomes from study subjects; with corneal interface and IOP in experimental studies. RESULTS. Thirty-three subjects (22 females, 66.7%) underwent FLEx in both eyes (66 eyes). Mean age was 32 years (range, 21 to 46 years). Preoperative mean SE was Ϫ5.77 Ϯ 2.04 D with astigmatism of Ϫ1.03 Ϯ 0.72 D. There was a slight hyperopic shift (mean SE 0.14 Ϯ 0.53 D); 94% achieved uncorrected visual acuity Ն20/25 3 months postoperatively. Refractive stability was achieved within 1 month (P Ͻ 0.001). Ultrastructurally, the smoothness of the corneal interface was independent of ablation depth (mean irregularity scores A, B, C: 8.8 Ϯ 0.6, 10.3 Ϯ 0.4, 8.7 Ϯ 0.6, respectively; P ϭ 0.88). The increase in IOP during FLEx was similar to that in femtosecond (FS)-LASIK, albeit a twofold duration of raised IOP in FLEx (P Ͻ 0.001). CONCLUSIONS. These results suggest that FLEx is predictable and effective in treating myopia and myopic astigmatism. Experimental studies support the early clinical results and safety of this procedure. (Invest Ophthalmol Vis Sci. 2012;53: 1414 -1421) DOI:10.1167/iovs.11-8808 T he femtosecond (FS) laser is a near-infrared neodymiumdoped yttrium aluminum garnet (ND:YAG) laser that photodisrupts the cornea with surgical precision through plasma cleavage of stromal lamellae.1 The first commercial ophthalmic FS laser was introduced into the market in 2001 for laser in situ keratomileusis (LASIK) flaps. Since then, significant improvements in laser energy profiles, spatial resolution, and faster laser speeds have occurred.2 FS lasers have thus made a significant impact on refractive surgery by enabling nonmechanical creation of a corneal flap during LASIK. The FS laser offers several advantages over manual microkeratomes including increased precision, reduced incidence of flap complications, and the ability to cut thinner flaps without the risk of buttonhole formation.3,4 Moreover, newer generation FS lasers have reduced problems such as transient lightsensitivity syndrome and interference by cavitation bubbles. 5,6

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“…With a mechanical microkeratome, complications following flap creation have been reported. These include epithelial sloughing, epithelial defects, free/partial flaps, and button holes [6,7]. The femotosecond laser produces fewer complications in comparison to the microkeratome [8].…”

Section: Side Effects Of Lasikmentioning

confidence: 99%

A Review of Corneal Biomechanics after LASIK and SMILE and the Current Methods of Corneal Biomechanical Analysis

Yang¹,

Roberts²

2015

J Clin Exp Ophthalmol

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Corneal refractive surgeries for the correction of myopia, hyperopia, astigmatism and hyperopia are quick and effective procedures, and have been growing in popularity over the last two decades. However, post-surgery corneal ectasia remains one of the most feared surgical complications. This is where the biomechanical integrity of the cornea begins to fail, with progressive thinning of the stroma, steepening of the cornea, irregular astigmatism, and decreased distance visual acuity. Laser-assisted in-situ keratomileusis (LASIK) is currently the most common refractive surgery procedure. It uses a femtosecond laser or a microkeratome to cut a thin flap on the surface of the cornea. Corneal tissue is then photoablated to correct the refractive error and the flap is then replaced at the end of the procedure. Newer techniques such as small incision lenticule extraction (SMILE) make use of a small incision only, without flap creation, and a lenticule is extracted to correct the refractive error. The avoidance of flap creation should theoretically maintain the integrity of the anterior corneal region and lower the risk of corneal ectasia, but there have been few clinical studies to date that compare the corneal biomechanical outcomes of different procedures. In this review, we highlight the biomechanical differences in outcomes between LASIK and SMILE, as well as explain some of the in vivo and in vitro techniques to investigate corneal biomechanical parameters.

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Microkeratome complications

Abstract: The aim of this review is to report complications associated with mechanical microkeratomes in the construction of laser in-situ keratomileusis flaps and to see whether there is a significant disadvantage compared with the femtosecond laser.

Cited by 19 publications

References 30 publications

Effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis

Effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser–assisted laser in situ keratomileusis

Femtosecond Lenticule Extraction (FLEx): Clinical Results, Interface Evaluation, and Intraocular Pressure Variation

A Review of Corneal Biomechanics after LASIK and SMILE and the Current Methods of Corneal Biomechanical Analysis

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