1: Curr Opin Ophthalmol. 2006 Aug;17(4):368-72.

Advances in refractive surgery: microkeratome and femtosecond laser flap
creation in relation to safety, efficacy, predictability, and biomechanical
stability.

Stonecipher K, Ignacio TS, Stonecipher M.

The Laser Center, Greensboro, North Carolina 27410, USA. StoneNC@aol.com

PURPOSE OF REVIEW: Methods of flap creation have changed over the years from the
evolution of the mechanical microkeratome to the introduction of the IntraLase
femtosecond laser keratome, both of which have different mechanisms of action to
create corneal resections. Previous studies report the advantages and
disadvantages of the mechanical microkeratome and the IntraLase femtosecond
laser. The critical components in laser in-situ keratomileusis surgery remain
the same, however: safety, efficiency, predictability, and biomechanical
stability. RECENT FINDINGS: Keratoectasia and flap efficiency remain a constant
safety concern in laser in-situ keratomileusis surgery. Unexpectedly thick flaps
as well as variable thickness continue to be a concern with safety in relation
to microkeratome technology. Epithelial preservation, flap complications, and
newer issues such as Transient Light Sensitivity Syndrome are safety concerns of
flap creation. Improved outcomes with regards to vision, induced astigmatism,
induced higher-order aberrations, and enhancement rates are seen to favor
predictability of femtosecond technologies over the microkeratome. Recent
biomechanical studies show improved healing with femtosecond laser flap creation
compared with blade-assisted flap creation. SUMMARY: The aim of this review is
to summarize the key components for both the microkeratome and the femtosecond
laser and to update on the recent advances reported on these topics.

PMID: 16900030 [PubMed - indexed for MEDLINE]