May 29, 2004
The thick and thin of LASIK flaps
JCRS MAY 2004
We began using the Amadeus microkeratome (AMO).we performed intraoperative pachymetry Our and others' experience with the Hansatome® microkeratome (Bausch & Lomb Surgical) suggested that the flaps tended to be thinner than the plate designation. Astonishingly, we found that the new device's 180 ?m plate produced flap thicknesses ranging from 198 to 258 ?m and the 160 ?m plate produced flaps as thick as 220 ?m.
How should we respond?
As suggested here before we should consider :
1-measuring flap thickness intraoperatively in all patients. It ensures that one does not ablate too deeply into the posterior stroma, enables the surgeon to determine whether the patient can have retreatment surgery in the future, and educates the surgeon about the performance of the microkeratome.
2-We should reconsider the manner in which microkeratome plates are labeled. A single number clearly is inadequate and inaccurate. Solomon et al. suggest labeling plates with the mean thickness ± 2 SDs so surgeons could at least estimate the range of flap thickness for 95% of cases. Perhaps we should consider something slightly more drastic, which would be to label plates according to published ranges of flap thicknesses. Therefore, the Amadeus 140 ?m plate might henceforth be known as the 80–195 ?m plate. This dispels any illusions that clinicians might have regarding the actual flap thickness in any given eye.
Posted by alireza habibollahi at May 29, 2004 10:37 PM