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Orry Birdsong, Alexander Davis, Kevin Merkley; Incidence of Microtome Complications of Corneal Refractive Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3942.
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© ARVO (1962-2015); The Authors (2016-present)
Laser in situ Keratomileusis has been increasingly popular for the correction of refractive error in applicable patients. While many various studies have described and quantified the complications of LASIK with microkeratome use, few have looked in patient and instrumentation specific etiologies for these complications. In this retrospective observational study, we recognize common microkeratome complications with LASIK and identify potential etiologies and safeguards for these complications.<br />
LASIK procedure cases performed a private LASIK center were retrospectively reviewed identifying complications over a time frame of 27 months between 2011-2013. 26 complications were then identified and categorized. Patient demographics, microkeratome depth and ring size, average corneal thickness, corneal cylinder, best corrected visual acuity pre and post treatment, pachymetry, flap thickness, white to white measurement, and refractive error spherical equivalent were reviewed. Cases were then further reclassified by subsequent retreatment methods to evaluate resolution after complications occurred and correlations determined based on findings.
Of the 26 complications identified, 4 button hole flaps, 5 non-button hole flaps, 2 decentered flaps, 3 free caps, 4 irregular flaps, and 8 partial flaps were identified. Average age of patients was 38.12 years and 38% of cases were female and 62% male. In 96% of noted complications, the 120um microkeratome was used, and in 73% of noted complications, the 9.5mm ring size was used. Average K thickness was 43.42 D. Average corneal cylinder was -1.06. Average pachymetry measured by ultrasound and Orbscan were 549.08 and 534.73 respectively. Average white to white measurement was 11.88mm. Average refractive error spherical equivalent was -2.47 D. 65% patients with complication underwent retreatment. Of these patients, 23% underwent recutting and the remaining 77% underwent PRK.
Higher rates of complication were noted with the 120um microkeratome depth and 9.5mm ring size. Our results also show that complications arise more in myopic patients. Although microkeratome complication rates are low overall in the number of reviewed cases, continued prospective confirmation of these risk factors can allow for careful consideration of these parameters when performing LASIK procedures.
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