Experimental evaluation of two current-generation automated microkeratomes: the Hansatome and the Supratome

To compare flap dimensions, cut quality, and blade deterioration after reuse in an experimental setting using two current-generation microkeratomes for laser-assisted in situ keratomileusis.

Two pivoting-head principle microkeratomes, the Hansatome and the Supratome, were used to perform a corneal flap in 50 freshly enucleated pig cadaver eyes, with an intended thickness of 160 microm. Provided stainless steel blades were used from one to five times. Flap diameter was measured by planimetry and thickness calculated using ultrasonic pachymetry at three different locations. Scanning electron microscopy of stromal beds and blades' cutting edges were performed to assess the cut and blade deterioration after repeated use.

Mean flap central thickness (Hansatome/Supratome) was 151 microm (SD 18)/192 microm (SD 32). Progressive thinning/thickening of the flap was observed in the direction toward the hinge (P = .003/P = .021). Mean vertical flap diameters of 8.9 mm (SD 0.3)/8.0 mm (SD 0.4) differed significantly (P = .001). No correlation was found between thickness and diameter (r = 0.03, P = .935/r = 0.12, P = .603). At scanning electron microscopy, smooth cuts were observed with both keratomes using a new blade. Periodical chatter lines at keratectomy edge were present and were more pronounced after blade reuse. Cut quality, blade deterioration, and small tissue remnants on the blade surface were noted with repeated blade use, especially using the Supratome.

Local flap thickness and flap diameter variations are inherent to the instrument used. Comparable cut-surface quality can be obtained with new blades. Although cut and blade deterioration appears to be minor after two reuses, the presence of tissue remnants on the blade surface still limits its reuse.