Femtosecond laser versus mechanical microkeratomes for flap creation in laser in situ keratomileusis and effect of postoperative measurement interval on estimated femtosecond flap thickness

Abstract

PURPOSE: To prospectively compare laser in situ keratomileusis (LASIK) flaps created with a femtosecond laser or a mechanical microkeratome and analyze the effect of the postoperative measurement interval on estimated femtosecond flap thickness using ultrasound (US) pachymetry. SETTING: Department of Ophthalmology, University Hospital of Coimbra, and Coimbra Surgical Centre, Coimbra, Portugal. METHODS: Flaps were created with a Hansatome Zero Compression microkeratome (Group 1), Zyoptix XP keratome (Group 2), or IntraLase 60 kHz femtosecond laser (Groups 3 and 4). Flap thickness was determined by intraoperative US pachymetry immediately after flap creation in Groups 1, 2, and 3. In Group 4, pachymetry was performed 20 minutes after the laser treatment. The main outcome measures were flap thickness and deviation from the target value. RESULTS: Eighty patients had LASIK for myopia or myopic astigmatism. The mean flap thickness was 149.1 μm ± 24.9 (SD) in Group 1, 124.7 ± 23.8 μm in Group 2, 143.1 ± 18.4 μm in Group 3, and 115.5 ± 12.5 μm in Group 4. The difference in flap thickness between Group 3 and Group 4 was statistically significant (P<.01). The flap thickness deviation from the target value was 22.8 μm in Group 1, 19.0 μm in Group 2, 26.1 μm in Group 3, and 10.4 μm in Group 4. CONCLUSIONS: Results indicate that the time of measurement after femtosecond affects the estimated flap thickness. Waiting 20 minutes after laser treatment permitted easier separation and may eliminate the effect of variable corneal dehydration on flap measurement by subtraction pachymetry.