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J. Myung, A. J. Kanellopoulos; Comparison of Femtosecond Lasik to Mechanical Microkeratome Lasik in 1000 Consecutive Cases. Invest. Ophthalmol. Vis. Sci. 2009;50(13):547.
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© ARVO (1962-2015); The Authors (2016-present)
A retrospective comparison of 1000 consecutive eyes that underwent laser in situ keratomileusis (LASIK) using a femtosecond laser keratome to 1000 eyes that underwent LASIK using a mechanical microkeratome.
1000 consecutive LASIK cases using the femtosecond laser keratome (Intralase FS60; Advanced Medical Optics, Inc, Santa Anna, California) and the Eye-Q 400 Hz Wavelight excimer laser (Wavelight AG, Inc, Erlangen, Germany) were evaluated before and after LASIK with a comprehensive examination including refraction, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), pentacam topography, wavefront analysis, contrast sensitivity and slit lamp biomicroscopy. The results were compared with a matched group of 1000 cases treated with the M2 microkeratome and the same excimer laser.
Of the 1000 femtosecond LASIK cases, 825 eyes were myopic and 175 eyes were hyperopic. The mean preoperative UCVA for the myopic eyes was 20/80, and the mean postoperative UCVA for these eyes was 20/17 with a mean flap thickness of 105 microns (+/- 5 microns). For the hyperopic eyes that underwent femtosecond LASIK, the mean preoperative UCVA was 20/60, and the mean postoperative UCVA was 20/15 with a mean flap thickness of 132 microns (+/- 7 microns). Similar visual acuity results were obtained in the microkeratome LASIK group. Three minor flap complications occurred in the femtosecond LASIK group. Two were managed intraoperatively, and one was treated within 2 months by microkeratome without loss of UCVA. In the microkeratome group, there were six flap complications which all required subsequent PRK. In the femtosecond cases, there were 2 cases of an epithelial abrasion, one case of a buttonhole but no incidences of flap slippage, epithelial downgrowth or diffuse lamellar keratopathy (DLK). In comparison, the microkeratome group had six cases of flap striae, 22 cases of epithelial downgrowth, 3 cases of a buttonhole, 65 cases of epithelial abrasions, and 12 cases of DLK.
In this large study, we found that for a single surgeon utilizing the same excimer laser, the femtosecond laser keratome compared to the mechanical microkeratome for LASIK appears to be superior in reducing postoperative complications. Specifically, it reduced the risk for DLK, flap complications, flap striae, epithelial downgrouth and may result in a safer, more effective visual rehabilitation.
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