Refractive Surgery Focus on the Lasik Flap’s Creation

FEBRUARY 2010 CATARACT & REFRACTIVE SURGERY TODAY 49 MARK E. JOHNSTON, MD, FRCSC The three primary concerns with any microkeratome are safety, results, and cost. My colleagues and I have used the IntraLase FS laser (Abbott Medical Optics Inc., Santa Ana, CA) in more than 1,000 cases and the Zyoptix XP microkeratome (Technolas Perfect Vision, Saint Louis, MO) in over 10,000 cases. Both procedures have been very safe. One incomplete flap occurred with the microkeratome, but we have rarely experienced slipped flaps, diffuse lamellar keratitis, or recurrent erosions with either procedure. The lower cost of the microkeratome, however, has given us a competitive advantage in maintaining our surgical caseload and referral base during the last year. When we initially looked at the results of our IntraLase procedures, we compared them to a historically matched group of microkeratome procedures and noted similar outcomes. Based on this comparison, we recommended IntraLase to patients who required high corrections and had thin corneas. Clinically, we noted an increase in the number of enhancements we performed. Using the Refractive Surgery Consultant (Refractive Consulting Group, Scottsdale, AZ), we found that patients with higher degrees of preoperative myopia (> 6.00 D) who underwent the IntraLase procedure experienced more myopic regression after surgery and a higher standard deviation than patients whose LASIK procedures we performed with the Zyoptix XP microkeratome. We reported these results in a poster presented at the 2009 ASCRS meeting. Specifically, 87 eyes with greater than 6.00 D of myopia and less than 1.50 D of cylinder underwent VISX CustomVue wavefront-guided LASIK (Abbott Medical Optics Inc.). In the 50 eyes where we created the LASIK flap with the Why I Use a Microkeratome