Flap creation with laser can improve visual outcoms

September 15, 2004

San Diego-Creating a flap with the IntraLase laser (IntraLase Corp.), regardless of the type of ablation that followed IntraLase flap creation, seemed to improve the visual outcomes significant-ly compared with creating a flap with a microkeratome. The IntraLase laser proved to be safe and effective and may have had a greater impact on outcomes in clinical practice than using customized wavefront-guided ablations, according to Richard Launer, MD.

"When considering whether to incorporate IntraLase into my practice, I was motivated largely by the safety profile, trying to reduce intraoperative complications, and to create thinner flaps with tighter precision and accuracy," Dr. Launer said here at the annual meeting of the American Society of Cataract and Refractive Surgery.

"When I initially started thinking about IntraLase about 1 year ago, I did not think about it producing better visual outcomes," he added.

No serious complications occurred in any groups, but Dr. Launer reported that there was more limbal bleeding and epithelial defects in the Moria microkeratome group. One case of loss of suction occurred in the IntraLase group, which was subsequently completed without complications.

The average preoperative sphere was slightly higher in the standard treatment groups and slightly lower in the customized groups. The mean preoperative sphere in the group treated with the IntraLase laser with wavefront-guided ablation was -3.68 D (range, 0.5 to -6 D). In the group treated with IntraLase laser with the standard ablation, the mean preoperative sphere was -4.15 D (range, -0.25 to -9.75 D). And in the group treated with the Moria microkeratome with the standard ablation, the mean preoperative sphere was -4.54 D (range, 0.5 to -8.5 D).

"In the group treated with IntraLase with wavefront-guided ablation, the postoperative uncorrected visual acuity (UCVA) was 20/20 or greater in 70% of eyes and 20/40 or greater in 97% of eyes. In the group treated with IntraLase and wavefront-guided ablation with the adjusted nomogram, the UCVA was 20/20 or greater in 83% of eyes. In the group treated with IntraLase with the standard ablation, the UCVA was 20/20 or greater in 68% and 20/40 or better in 96%. In the group treated with the microkeratome and the standard ablation, the UCVA was 20/20 or better in 52% and 20/20 or better in 98%," Dr. Launer reported.

In the eyes that did not reach 20/20 UCVA, about 74% were undercorrected by an average 0.5 D, and the rest were slightly overcorrected by about 0.5 D.

"All the IntraLase groups were statistically better than the microkeratome group, yet there was no statistical difference among the results from the IntraLase groups regardless of whether there was standard, wavefront-adjusted, or nomogram-adjusted treatment," he commented.

Dr. Launer also reported the results from a group of 153 eyes that had been treated more recently with the IntraLase laser. One month after treatment, 78% had an UCVA of 20/20 or better and 18% were 20/15 or better. Three months after treatment, the results improved, with 84% at 20/20 or better and 20% at 20/15 or better.

He demonstrated the straightforward IntraLase technique.