Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis

Abstract

Jens Heichel,1 Frank Wilhelm,2 Kathleen S Kunert,3 Rabea Schlueter,4 Ute Stuhltraeger,1 Thomas Hammer5 1Department of Ophthalmology, University Hospital of Martin Luther University Halle/Wittenberg, Halle (Saale), Germany; 2Augen im Zentrum, Greifswald, Germany; 3Department of Ophthalmology, Helios Klinikum Erfurt, Erfurt, Germany; 4Institute of Microbiology, Ernst-Moritz-Arndt-University, Greifswald, Germany; 5Augenzentrum Frohe Zukunft, Halle (Saale), Germany Purpose: Femtosecond lasers have become the standard for laser-assisted in situ keratomileusis (LASIK) flap creation, but advanced mechanical microkeratomes are still an alternative, more cost-effective way to create the flap. The SCHWIND Carriazo-Pendular microkeratome is one of the most commonly used microkeratomes. The influence of different cutting parameters (head-advance speeds, cutting heads) on morphology of LASIK cuts was investigated. Setting: Experimental study performed at the University Eye Hospital of the Martin Luther University Halle/Wittenberg, Halle (Saale), Germany. Methods: The Carriazo-Pendular microkeratome was used on freshly enucleated porcine eyes for lamellar keratotomy. After flap removal, the cutting edge and stromal bed were evaluated from scanning electron micrographs using an individualized scoring system. Four different settings of microkeratome parameters were compared. For each setting, eight cuts were evaluated (n=32). Results: Different oscillation frequencies and head-advance speeds did not influence the cutting qualities. A higher oscillation/feed rate ratio seemed to be advantageous for a smoother interface. Concerning different cuttings heads, a deeper keratotomy led to sharper cutting edges. The thinner the flap, the more irregularities in the stromal bed appeared. Complications did not occur. Conclusion: The Carriazo-Pendular microkeratome is a safe tool with which to create a LASIK flap and is a good alternative to a costly femtosecond laser. Deeper keratotomies, as well as the use of a higher oscillation/feed rate quotient, improve the cutting quality. Keywords: laser-assisted in situ keratomileusis (LASIK), microkeratome, stromal bed quality, surface regularity, Descemet's stripping automated endothelial keratoplasty (DSAEK), scanning electron microscopy (SEM)