[In-vitro comparison of morphology of current microkeratomes for LASIK]

We have performed an in-vitro examination of the morphology of flap thickness and stromal bed after LASIK in porcine eyes.

Freshly enucleated porcine eyes and synthetic eye models were used for cutting flaps with the microkeratomes Hansatome-Excellus (Bausch&Lomb), M2 single use (Moria), Amadeus (AMO), MK-2000 (Nidek) and Carriazo-Pendular (Schwind). The flap thickness of porcine eyes was determined using a non-contact, confocal optical distance measuring device (CHR 150N, Jurca), in the eye models a mechanical thickness measuring device (Käfler) was used. The morphology of the stromal bed was examined by photography, histology, scanning electron microscopy and confocal optical distance measurements.

The optical/mechanical flap thickness measurements showed an average difference compared to the adjusted thickness of - 3/+ 90 microm (Hansatome-Excellus), + 7/+ 100 microm (M2 single use), - 35/+ 40 microm (Amadeus), - 4/+ 80 microm (MK-2000) and + 11/+ 0 microm (Carriazo-Pendular). Histology showed no mechanical damage and smooth, slightly undulating surfaces with all microkeratomes. In the scanning electron microscopic examination, the stromal surface was found to be homogeneous and smooth for all of the microkeratomes. Average roughness of the ablation surface was 0.27 microm (Hansatome-Excellus), 0.23 microm (M2 single use), 0.21 microm (Amadeus), 0.23 microm (MK-2000) and 0.29 microm (Carriazo-Pendular).

The stromal bed showed in all cases only a slightly roughness, which seems to be acceptable for the clinical outcome. However, the more critical point is the large variations in flap thickness compared to the intended thickness.