Effect of lamellar flap location on corneal topography after laser in situ keratomileusis

To investigate the effect of hinge position on corneal topography after laser in situ keratomileusis (LASIK) for myopia.

Academic center and refractive surgery practice.

Topography data obtained from 89 eyes of 46 patients after LASIK were analyzed. Using a system of Cartesian coordinates, data along the horizontal and vertical axes were analyzed, measuring sagittal height and power change at 1 mm intervals from the ablation zone center. Data points that were equidistant and on opposite sides of the ablation center were compared to find asymmetry along either axis relative to nasally hinged flaps.

Along the horizontal axis, areas of the cornea closer to the hinge had a higher topography than areas farther from the hinge. Specifically, the points nearest and farthest from the hinge were significantly different in sagittal height (P <.034); the areas farthest from the hinge were reduced more after surgery (relatively lower topography). When results were stratified into low- and high-diopter corrections, this difference was significant in only the high-diopter group (P <.0006). Trends in power change were also observed. Areas of the cornea closer to the hinge were relatively flatter than areas farther from the hinge. Statistical significance was detected in only the low-diopter group at data points 2 mm from the ablation zone center in opposite directions (P <.008). No asymmetry was seen along the vertical axis in power change or sagittal height.

The lamellar flap in LASIK may influence postoperative corneal topography. Hypothetically, the corneal flap may retract toward the hinge, producing axial asymmetry in the postoperative topography relative to the hinge. Understanding the influence of corneal flap characteristics on post-LASIK topography may improve optical results and may be particularly important in the development and effectiveness of topography-guided ablation techniques.