Study supports safety of femtosecond LASIK

October 15, 2008

A retrospective study evaluated complications and associated outcomes in eyes that underwent LASIK with femtosecond laser flap creation at a university-based refractive surgery center. A direct or indirect complication due to flap creation occurred in 44 (0.92%) of 4,772 eyes; there was no loss of best spectacle corrected visual acuity in any of the 44 eyes.

Key Points

Miami-Results of a retrospective, noncomparative study designed to evaluate complications associated with use of the femtosecond laser (IntraLase, Advanced Medical Optics) for LASIK flap creation show such events occur with a low incidence and do not result in adverse long-term sequelae, said Sonia H. Yoo, MD.

The findings come from a review of 4,772 eyes that underwent a femtosecond laser (IntraLASIK) procedure between September 2003 and June 2006 at the refractive surgery center at the Bascom Palmer Eye Intitute, University of Miami School of Medicine.

Within the series, 44 eyes (0.92%) experienced a direct or indirect complication due to flap creation. The surgery was aborted in only one eye. The final refractive and visual outcomes were favorable in all eyes that experienced a complication, and none had a loss of best spectacle corrected visual acuity (BSCVA), said Dr. Yoo, associate professor of ophthalmology, Bascom Palmer Eye Institute.

"No eyes required surgical intervention for DLK, and at follow-up after 1 year, all were emmetropic without loss of BSCVA," Dr. Yoo said.

Track, manage complications

The most common flap-related complication was premature breakthrough of gas through the epithelium within the flap margins, which occurred in eight eyes (0.17%).

The other complications included creation of an incomplete flap in three eyes secondary to suction loss and an irregular flap in one eye, where previous corneal scarring interfered with the lamellar pass.

In addition, eight eyes developed gas bubbles in the anterior chamber with a significant opaque bubble layer that interfered with the laser pupil tracking/iris registration technology. Dr. Yoo noted that the eyes with incomplete flaps underwent immediate retreatment with a second pass performed at the same level and subsequently underwent immediate excimer laser ablation.

In the eyes in which gas bubbles in the anterior chamber interfered with laser pupil tracking/iris registration, the ablation was performed without that technology or after waiting a few hours for the bubbles to clear.

Because the bubbles were transient, they were not considered true complications of the procedure. All eyes with transient light sensitivity syndrome were treated with additional topical steroids without any severe consequences.

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