High-precision, high-speed measurement of excimer laser keratectomies with a new optical pachymeter

In excimer-laser photorefractive keratectomy (PRK) the depth of the stromal tissue ablation is calculated from calibration and empirical data but is not actually measured, since a noncontact high-precision instrument for the measurement of the actual ablation has not been available. With a newly developed method for optical pachymetry we studied the depth of corneal ablations performed with an excimer laser. The excimer laser (Schwind Keratom) was calibrated according to the manufacturers' instructions. On freshly enucleated pig eyes, planokeratectomies with a diameter of 5 mm and a planned depth of 20, 40, 80, 160, and 320 microns were performed. With a newly developed high-precision, high-speed reflectometer the corneal thickness was measured immediately before and after the keratectomy. All ablations were deeper than expected. For a planned keratectomy of 20 microns we found a mean ablation depth of 29 microns; for 40 microns, a mean depth of 51 microns; for 80 microns, a mean depth of 100 microns; for 160 microns, a mean depth of 200 microns; and for 320 microns, a mean depth of 396 microns. The differences between mean and maximal ablation values were 58.6% at the 20-micron setting, 40.9% at the 40-micron setting, 20.1% at the 80-micron setting, 11.5% at the 160-micron and 9.8% at the 320-micron setting. Ablation rates showed the highest degree of variation in the 20-micron ablation group. Absolute variations in the ablation depth increased with ablation depth. In photorefractive procedures the volume of the tissue ablated is calculated from the instrument calibration but is not actually measured. Although the greater than expected ablation depths may in part be explained by differences between human and porcine tissue, the high degree of variability in the laser ablations may have other causes. We suggest that variations in the postoperative refractive results of PRK, which are currently attributed to variations in corneal would healing, may in part be due to variations in ablation depth.