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Flap thickness accuracy: comparison of 6 microkeratome models
Kerry D Solomon1, Eric Donnenfeld, Helga P Sandoval
1Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC 29425, USA. solomonk@musc.edu
Journal of Cataract and Refractive Surgery
|May 8, 2004
Summary
Microkeratome flap thickness accuracy varied significantly among six models, with factors like corneal thickness and surgical order influencing results. Device labeling did not consistently predict flap thickness, highlighting the need for careful selection in laser vision correction.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Laser Vision Correction
Background:
- Accurate corneal flap thickness is crucial for refractive surgery outcomes.
- Microkeratomes are widely used for flap creation in laser in situ keratomileusis (LASIK).
- Variability in flap thickness can impact visual results and patient safety.
Purpose of the Study:
- To assess the flap thickness accuracy of six different microkeratome models.
- To identify factors influencing microkeratome flap thickness during LASIK procedures.
Main Methods:
- A multicenter prospective study involving 1061 patients and 18 surgeons.
- Evaluation of six microkeratome models: AMO Amadeus, Bausch & Lomb Hansatome, Moria Carriazo-Barraquer, Moria M2, Nidek MK2000, and Alcon Summit Krumeich-Barraquer.
- Measurement of intraoperative and residual bed pachymetry to determine estimated flap thickness.
Main Results:
- Significant differences in mean flap thickness were observed among the microkeratome models (P<.05).
- Microkeratome model, plate thickness, preoperative pachymetry, keratometry (Kmin), surgery order, head serial number, blade lot number, and surgeon explained 78.4% of flap thickness variability.
- Corneal thickness and surgical order (first vs. second cut) were significant predictors of flap thickness.
Conclusions:
- The study revealed considerable variability in flap thickness accuracy among the evaluated microkeratome models.
- Device labeling did not reliably predict achieved flap thickness, indicating inconsistency.
- Thinner corneas produced thinner flaps, thicker corneas produced thicker flaps, and first cuts were thicker than second cuts in bilateral procedures.