Laser in situ keratomileusis flap complications and complication rates using mechanical microkeratomes versus femtosecond laser: Retrospective review

Main Article Content

Karl G Stonecipher Jay J Meyer Megan Stonecipher David J Felsted http://orcid.org/0000-0002-2034-2820

Abstract

Purpose: To compare the frequency and types of flap complications when a femtosecond laser versus a microkeratome is used in flap creation for laser in situ keratomileusis (LASIK).

Methods:  Retrospective review of private and published results of intraoperative and postoperative complications seen with mechanical microkeratomes and the femtosecond laser. The data from 13,721 consecutive mechanical microkeratome created flaps and 10,348 consecutive femtosecond laser created flaps for LASIK performed by one surgeon (KS) were analyzed for this study.

Results:  A lower rate of intraoperative complications (incomplete flap, buttonhole, free cap, thin/irregular flap) was seen in the femtosecond created flaps (0.019%) compared to the microkeratome created flaps in this study (0.095%, p<0.001) and large published studies (0.80%, p<0.001).  Less postoperative complications (epithelial ingrowth, keratectasia) were also seen in the femtosecond group (0.03%) compared to the microkeratome group (0.14%, p=0.01). There were several complications seen that were unique to the femtosecond laser, including transient light sensitivity, anterior chamber bubbles and vertical gas breakthrough. 

Conclusions: Intraoperative and postoperative flap complications were significantly higher with mechanical microkeratomes compared to the femtosecond laser.  Femtosecond laser flap creation resulted in some complications that were unique to this modality.

Key Words: LASIK, Flap Complications, Microkeratome, Intralase, Femtosecond Laser

Article Details

How to Cite
STONECIPHER, Karl G et al. Laser in situ keratomileusis flap complications and complication rates using mechanical microkeratomes versus femtosecond laser: Retrospective review. Medical Research Archives, [S.l.], v. 2, n. 3, sep. 2015. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/353>. Date accessed: 30 dec. 2024.
Keywords
LASIK, Flap Complications, Microkeratome, Intralase, Femtosecond Laser
Section
Research Articles

References

1. Duffey RJ, Leaming D. U.S. Trends in Refractive Surgery: 2011 ISRS Survey
- Partner of AAO –Presented at the American Academy of Ophthalmology, Orlando, FL, October, 2011.

2. Jacobs JM, Taravella MJ. Incidence of intraoperative flap complications in laser in situ keratomileusis. J Cataract Refract Surg. 2002;28(1):23-28

3. Moshirfar M, Gardiner JP, Schliesser JA, et al. Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison. J Cataract Refract Surg. 2010;36(11):1925-1933.

4. Binder PS. One thousand consecutive IntraLase laser in situ keratomileusis flaps. J Cataract Refract Surg. 2006;32(6):962-969.

5. Chang JS. Complications of sub-Bowman’s keratomileusis with a femtosecond laser in 3009 eyes. J Refract Surg. 2008;24(1):S97-101.

6. Haft P, Yoo SH, Kymionis GD, Ide T, O'Brien TP, Culbertson WW. Complications of LASIK flaps made by the IntraLase 15- and 30 kHz femtosecond lasers. J Refract Surg 2009;25(11):979-984.

7. Carrillo C, Chayet AS, Dougherty PJ, et al. Incidence of complications during
flap creation in LASIK using the NIDEK MK-2000 microkeratome in 26,600
cases. J Refract Surg 2005; 21(5 Suppl):S655–S657.

8. Nakano K, Nakano E, Oliveira M, et al. Intraoperative microkeratome complications in 47,094 laser in situ keratomileusis surgeries. J Refract Surg 2004;20(5 Suppl):S723–S726.

9. Albeda-Valle’s JC, Martin-Reyes C, Ramos F, Beltran J, Llovet F, Baviera J. Effect of preoperative keratometric power on intraoperative complications in LASIK in 34,099 eyes. J Refract Surg. 2007;23(6):592-597.

10. Stonecipher KG, Dishler JG, Ignacio TS, Binder PS. Transient light sensitivity after femtosecond laser flap creation: clinical findings and management. J Cataract Refract Surg. 2006;32(1):91-94.

11. Muñoz G, Albarrán-Diego C, Sakla HF, Javaloy J, Alió JL. Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser: Incidence and prevention. J Cataract Refract Surg. 2006;32(12):2075-2079.

12. Kaiserman I, Maresky HS, Bahar I, Rootman DS. Incidence, possible risk factors, and potential effects of an opaque bubble layer created by a femtosecond laser. J Cataract Refract Surg. 2008;34(3):417-423.

13. Stonecipher K.G., Ignacio T.I., Stonecipher, MN. Advances in Refractive Surgery: Microkeratome and femtosecond laser flap creation in relation to safety, efficacy, predictability, and biomechanical stability. Curr Opin Ophthalmol, 2006;17:368-372.

14. Durrie DS, Kezirian GM. Femtosecond laser versus mechanical keratome flaps in wavefront-guided laser in situ keratomileusis: prospective contralateral eye study. J Cataract Refract Surg. 2005;31(1):120-126.

15. Tran DB, Sarayba MA, Bor Z, et al. Randomized prospective clinical study comparing induced aberrations with IntraLase and Hansatome flap creation in fellow eyes: potential impact on wavefront-guided in situ keratomileusis . J Cataract Refract Surg. 2005;31(1):97-105.

16. Tanna M, Schallhorn SC, Hettinger KA. Femtosecond laser versus mechanical microkeratome: A retrospective comparison of visual outcomes at 3 months. J Refract Surg. 2009;25(7 Suppl): S668-671.

17. Kezirian GM, Stonecipher KG. Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis. J Cataract Refract Surg. 2004;30(4):804-811.

18. Polk EE, Wexler SA, Kymes S. Incidence of corneal epithelial defects with the standard and zero-compression hansatome microkeratomes. J Refract Surg. 2005;21(4):359-364.

19. Yau CW, Cheng HC. Microkeratome blades and corneal flap thickness in LASIK. Ophthalmic Surg Lasers Imaging 2008;39(6):471-475.

20. Rosa AM, Neto Murta J, Quadrado MJ, et al. Femtosecond laser versus mechanical microkeratomes for flap creation in laser in situ keratomileusis and effect of postoperative measurement interval on estimated femtosecond flap thickness. J Cataract Refract Surg 2009; 35(5):833–838.

21. Shemesh G, Dotan G, Lipshitz I. Predictability of corneal flap thickness in laser in situ keratomileusis using three different microkeratomes. J Refract Surg. 2002;18(3 Suppl):S347–S351.

22. Binder PS. Flap dimensions created with the IntraLase FS laser. J Cataract Refract Surg. 2004;30(1):26-32.

23. Kamburoğlu G, Ertan A. Epithelial ingrowth after femtosecond laser-assisted in situ keratomileusis. Cornea 2008; 27(10):1122–1125.

24. Gil-Cazorla R, Teus MA, de Benito-Llopis L, Fuentes I. Incidence of diffuse lamellar keratitis after laser in situ keratomileusis associated with the IntraLase 15 kHz femtosecond laser and Moria M2 microkeratome. J Cataract Refract Surg. 2008;34(1):28-31.

25. Javaloy J, Vidal MT, Abdelrahman AM, Artola A, Alió JL. Confocal microscopy comparison of Intralase femtosecond laser and Moria M2 microkeratome in LASIK. J Refract Surg. 2007;23(2):178-87.

26. Choe CH, Guss C, Musch DC, Niziol LM, Shtein RM. Incidence of diffuse lamellar keratitis after LASIK with 15 KHz, 30 KHz, and 60 KHz femtosecond laser flap creation. J Cataract Refract Surg. 2010;36(11):1912-1918.

27. Seider MI, Ide T, Kymionis GD, Culbertson WW, O’Brien TP, Yoo SH. Epithelial breakthrough during IntraLase flap creation for laser in situ keratomileusis. J Cataract Refract Surg. 2008;34(5):859-863.

28. Srinivasan S, Herzig S. Sub-epithelial gas breakthrough during femtosecond laser flap creation for LASIK. Br J Ophthalmol. 2007;91(10):1373.

29. Lifshitz T, Levy J, Klemperer I, Levinger S. Anterior chamber gas bubbles after corneal flap creation with a femtosecond laser. J Cataract Refract Surg. 2005;31(11):2227-2229.

30. Srinivasan S, Rootman DS. Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK. J Refract Surg. 2007;23(8):828-830.

31. Stonecipher, K.G., Ignacio, T.I., Stonecipher, K.G. Complications and management with the femtosecond laser. Management of Complications in Refractive Surgery, Edited by Jorge L. Ailo and Dimitri Azar. Springer Verlag Berlin Heidelberg, 169-174, 2008.

32. Marshall J. IntraLase: The Most Versatile Femtosecond Laser Choice. CRST Europe. 2007.

33. Davison J, Johnson S. Intraoperative Complications of LASIK Flaps Using the IntraLase Femtosecond Laser in 3009 Cases. J Refract Surg. 2010; 26(11):851-857.