Mechanical microkeratome a viable choice for reliable thin-flap LASIK

Thin flaps can be created safely and precisely using a mechanical microkeratome (Carriazo-Pendular, Schwind eye-tech-solutions), said Stephen E. Pascucci, MD, a private practitioner in Bonita Springs, FL, and affiliate assistant professor of ophthalmology, University of South Florida, Tampa.

Dr. Pascucci reported his experience using the Carriazo-Pendular microkeratome equipped with the 110-µm head for creating superiorly hinged flaps in 110 eyes of 55 consecutive patients. Spherical error in the series of eyes ranged from –6 to 3 D and all eyes had 2 D or less of astigmatism.

There were no aborted cases. Horizontal flap diameter ranged from 8.5- to 10-mm and was appropriate for the intended ablation. Flap thickness was measured with ultrasonic pachymetry prior to ablation and averaged 111.3 µm with a standard deviation of 11.8 µm and a range from 82 to 128 µm. All flaps had very clean edges with no irregularity, the stromal beds were very smooth, and there were no abrasions, buttonholes, striae, or complications.

"Ectasia is a persistent concern of refractive surgeons and so there continues to be a need to achieve consistently thin flaps that will leave as much stromal tissue as possible after the ablation," Dr. Pascucci said. "My own preference was to be able to continue to perform LASIK on thinner corneas instead of having to go back to the surface and subject patients to the inconveniences, albeit short-term, of those procedures.

"I have used a number of microkeratomes and am familiar with their strengths and weaknesses. The Carriazo-Pendular mechanical microkeratome has a number of attractive safety features and is easy to use. In addition, it creates flaps that are more planar and femtosecond-like in their appearance and with good thickness predictability. In fact, the standard deviation of flap thickness seems to tighten more with attempts to create thinner flaps," he concluded.