Evaluation of Enhancement Rates Evaluation of Enhancement Rates following Hyperopic LASIK with following Hyperopic LASIK with

Femtosecond versus Microkeratome Femtosecond versus Microkeratome Assisted Flap CreationAssisted Flap Creation

Raj Rajpara, BS *Raj Rajpara, BS *Richard M. Awdeh, MD *Richard M. Awdeh, MD *Bryan C. Hainline, MD *Bryan C. Hainline, MD *

William W. Culbertson, MD **William W. Culbertson, MD **Sonia H. Yoo, MD **Sonia H. Yoo, MD **

Bascom Palmer Eye InstituteBascom Palmer Eye Institute

*No financial interests*No financial interests**Consultants for AMO**Consultants for AMO

PurposePurpose

• To evaluate the rate of enhancement To evaluate the rate of enhancement following hyperopic LASIK in patients following hyperopic LASIK in patients who underwent femtosecond laser who underwent femtosecond laser assisted flap creation versus traditional assisted flap creation versus traditional microkeratome assisted flap creation.microkeratome assisted flap creation.

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MicrokeratomeMicrokeratome

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Advantages:• Faster• Cheaper• No alternative in past

Disadvantages:• Flap is not reproducible• Variability in flap thickness• Partial Flap; Buttonhole • Increase rate of enhancement surgery 1

1Stonecipher K. Advances in refractive surgery: microkeratome and femtosecond laser flap creation in relation to safety, efficacy, predictability, and biomechanical stability. Current Opinion in Ophthalmology, August 2006

MethodsMethods

• Retrospective Chart review of 83 eyes Retrospective Chart review of 83 eyes from 45 patients who underwent from 45 patients who underwent Hyperopic LASIK at Bascom PalmerHyperopic LASIK at Bascom Palmer• Microkeratome Group: (Moria)Microkeratome Group: (Moria)

44 eyes of 23 consecutive patients treated 44 eyes of 23 consecutive patients treated between 2002 and 2004between 2002 and 2004

• Femtosecond Laser Group: (Intralase 15 kHz)Femtosecond Laser Group: (Intralase 15 kHz) 39 eyes of 22 consecutive patients treated 39 eyes of 22 consecutive patients treated

between 2004 and 2006between 2004 and 2006

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MethodsMethods• Patients who did not receive a manifest Patients who did not receive a manifest

refraction at the POM # 1 visit were refraction at the POM # 1 visit were excluded from this analysis, leaving:excluded from this analysis, leaving:• Microkeratome group: 21 eyes of 11 patientsMicrokeratome group: 21 eyes of 11 patients• Femtosecond laser group: 24 eyes of 13 patients.Femtosecond laser group: 24 eyes of 13 patients.

• Uncorrected visual acuity (UCVA), best spectacle Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of corrected visual acuity (BSCVA), predictability of target spherical equivalent versus achieved target spherical equivalent versus achieved spherical equivalent, complication rate, and rate of spherical equivalent, complication rate, and rate of enhancement were analyzed for each groupenhancement were analyzed for each group

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Post Operative Month # 1Post Operative Month # 1

# Mean Min Max

Age (yr) 24 53.38 23 66

Preop UCVA (logmar)

24 0.578 0 1.301

Preop Mrx (SE)

24 1.88 0.5 5.25

Target Refrac-tion (SE)

24 -0.656 -1.875 .5

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# Mean Min Max

Age (yr) 21 58 46 68

Preop UCVA (logmar)

21 0.58 0.097 1.301

Preop Mrx (SE)

21 1.48 -0.25 3

Target Refrac-tion (SE)

21 -0.893 -2.5 0

Femtosecond Laser GroupMicrokeratome Group

Post Operative Month # 1Post Operative Month # 1

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Target Refraction (SE)

Preop UCVA 20/x

MK

FSFS

MK

Post Operative Month #1Post Operative Month #1ResultsResults

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Femtosecond LaserMicrokeratome

Post Operative Month #3Post Operative Month #3ResultsResults

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Microkeratome Femtosecond Laser

Post Operative Month #6Post Operative Month #6ResultsResults

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Microkeratome Femtosecond Laser

Rate of EnhancementsRate of Enhancements

• Microkeratome GroupMicrokeratome Group• 9 eyes out of 21 (42.9%) needed 9 eyes out of 21 (42.9%) needed

enhancement in the microkeratome groupenhancement in the microkeratome group

• Femtosecond Laser GroupFemtosecond Laser Group• Zero patients out of 24 eyes in the intralase Zero patients out of 24 eyes in the intralase

group needed enhancements group needed enhancements

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ConclusionConclusion

• Both groups had relatively good Both groups had relatively good predictability in terms of post-operative predictability in terms of post-operative spherical equivalent compared to pre-spherical equivalent compared to pre-operative target spherical equivalentoperative target spherical equivalent

• The enhancement rate was greater in The enhancement rate was greater in the microkeratome group (9 of 21 eyes) the microkeratome group (9 of 21 eyes) versus the femtosecond laser group (0 versus the femtosecond laser group (0 of 24 eyes) in this analysis.of 24 eyes) in this analysis.

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