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Tracker-assisted LASIK.

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Sandra M Brown. 2003. Tracker-assisted LASIK.. https://doi.org/10.1016/j.ophtha.2003.08.005

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Corneal flap thickness and topography changes induced by flap creation during laser in situ keratomileusis.

PURPOSE: To determine the corneal flap thickness profile produced by 3 microkeratomes and the topographic changes induced by flap creation in laser in situ keratomileusis (LASIK). SETTING: Cornea and Refractive Surgery Unit, Instituto de Microcirugia Ocular de Barcelona, Autonoma University, Barcelona, Spain. METHODS: In this prospective consecutive nonrandomized comparative study, patients were divided into 2 groups. In Group 1 (75 eyes), 3 microkeratomes were used: Moria LSX One, Moria M2, and Amadeus (AMO); 25 eyes per microkeratome. Pachymetry was measured with a DGH pachymeter in the center of the cornea and 3.0 mm from the center at 4 cardinal points (superior, inferior, nasal, and temporal; 3 measurements at each point) before and after the cut. The flap thickness in each sector was calculated by subtracting the mean post-flap corneal thickness from the mean pre-flap corneal thickness. In Group 2 (33 eyes), the M2 microkeratome with a 130 microm plate was used to create a superotemporal hinged flap (9 eyes) or a superonasal hinged flap (24 eyes). The topographic change induced by the microkeratome cut was evaluated using 4 sequential data acquisitions by the Keratron Scout topographic unit (Optikon) before and immediately after the cut (before laser ablation). Cardinal and oblique astigmatism and change in the axis were calculated by vectorial analysis of the simulated keratometry. Topographic Zernike analysis was performed in a subgroup. RESULTS: With the LSX One microkeratome, the mean flap thickness was 151.7 microm centrally, 161.9 microm superiorly, 151.4 microm inferiorly, 156.1 microm temporally, and 167.5 microm nasally. There was no statistically significant difference between the areas studied (P<.05). With the M2, the mean flap thickness was 131.7 microm centrally, 155.5 microm superiorly, 146.7 microm inferiorly, 143.7 microm temporally, and 160.5 microm nasally. There was a statistically significant difference between flap thickness centrally and in the other areas (P>.05). With the Amadeus microkeratome, the mean flap thickness was 140.0 microm centrally, 152.5 superiorly, 128.5 microm inferiorly, 145.0 microm temporally, and 147.0 microm nasally. Statistically significant differences (P>.05) were found in the 4 sectors of the flap. With vectorial analysis, there was no statistically significant difference between superonasal and superotemporal hinge placement in the cardinal and oblique components but there was a statistically significant difference in the axis change with both placements (P>.05). CONCLUSIONS: The LSX One microkeratome was the most predictable. A significant difference was noted in all sectors except superiorly with the M2 and in all sectors with the Amadeus. No differences between nasal and superior hinge placement were found with the M2. Topographic Zernike analysis demonstrated a difference in the orientation of the induced coma as a function of hinge position.

Corneal Stroma↗

Novel tissue adhesives to secure laser in situ keratomileusis flaps.

PURPOSE: To evaluate 2 novel biodendrimer tissue adhesives in sealing and securing laser in situ keratomileusis (LASIK) flaps. SETTING: Duke University Eye Center, Durham, North Carolina, USA. METHODS: Laser in situ keratomileusis flaps were created in 10 human eye-bank eyes using the Hansatome microkeratome system (Bausch & Lomb). These eyes were divided into 2 groups. Flaps in the first group (n=4) were secured with a laser-activated biodendrimer adhesive along the flap edge. In the second group (n=6), the flaps were secured with a self-gelling dendritic adhesive. Dry Merocel sponges (Medtronic Solan) were used to test the strength of flap adherence in both groups. Further testing was performed in the second group. The hinges of these flaps were cut with a scalpel blade and fluorescein dye was injected under the flap to observe potential dye leakage along the flap edge. RESULTS: Laser in situ keratomileusis flaps sealed with both adhesives were secure with no flap dislocation. There was no leakage of fluorescein dye observed in the second group. Both adhesives were easy to apply, clear when dry, and had a soft rubbery consistency. CONCLUSIONS: Two novel biodendrimer adhesives successfully sealed and secured LASIK flaps. These adhesives may prove to be an effective alternative for treating LASIK flap complications such as epithelial ingrowth or flap dislocation.

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