Flap creation: Laser? Mechanical?

January 1, 2010

A microkeratome is a safe and effective alternative to femtosecond laser for flap creation when performing sub-Bowman's keratomileusis, and the mechanical device offers a number of advantages as well.

Dr. Lewis compared the limitations and benefits of the second-generation mechanical microkeratome with those of the femtosecond laser.

He concluded that many of the advantages claimed for the femtosecond laser in terms of its reliability, safety, and flap architecture are at least matched by the microkeratome, while other theoretical benefits of flap creation using the femtosecond laser remain to be proven. There is no debating that the mechanical microkeratome has an advantage for lower cost and improving patient flow.

Economics

"Using [this microkeratome], my surgery day runs smoothly and on time," Dr. Lewis said.

Safety comparison

However, the risk of flap complications when the microkeratome is used in the hands of skilled surgeons is also extremely low, in part due to the outstanding suction and stability of the device.

In addition, IOP is elevated for less than 5 seconds during suction, flap elevation is easy both in the primary procedure and for enhancements, disposable blades and suction heads reduce the risk of infection and diffuse lamellar keratitis, and patients require minimal steroid use postoperatively.

"More intensive anti-inflammatory treatment is needed after a femtosecond laser procedure because of greater inflammation," Dr. Lewis said.