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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