LASIK with thin flaps using the Moria One Use-Plus microkeratome with the 130 disposable heads...
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Transcript of LASIK with thin flaps using the Moria One Use-Plus microkeratome with the 130 disposable heads...
LASIK with thin flapsusing the
Moria One Use-Plus microkeratomewith the 130 disposable heads
LASIK with thin flapsusing the
Moria One Use-Plus microkeratomewith the 130 disposable heads
Jérôme C. VRYGHEM, M.DJérôme C. VRYGHEM, M.D..
Brussels Eye DoctorsBrussels Eye Doctors
Brussels, BelgiumBrussels, Belgium
Jérôme C. VRYGHEM, M.DJérôme C. VRYGHEM, M.D..
Brussels Eye DoctorsBrussels Eye Doctors
Brussels, BelgiumBrussels, Belgium
No financial interest
Advantages of Thin Flaps
Cut through more superficial layers of the cornea More solid texture: less tendency to form tension lines/wrinkle The large corneal nerves trunks are below:
corneal sensation – more intact less dry eyes
Less epithelial defects The thinner the flap, the less epithelial trauma Plastic is more gently to the epithelium
Thicker residual corneal bed Greater safety: Further away from the 250 µm ectasia barrier More possibilities:
Thinner corneas can be treated Larger optical zones if needed can be treated Enhancements still possible without going too thin
• Ergonomic, pre-assembled and one-handed usage possible
• Metal suction ring• 4 stops (7.5, 8, 8.5, 9) to change hinge size
• 4 metal ring sizes to fit all keratometries (-1, 0, +1, +2)• 2 motors, one for blade oscillation, one for advancement
with metal ring
Moria One Use-Plus keratome
Single Use heads
130 head(for 130-µm flaps)
Moria One Use-Plus keratome
• Sterile device– Potentially lower incidence
of DLK– Decreases risk of
transmission of disease• Translucent head
– Makes it easier to visualize placement on the suction post
• Easy to assemble– No risk of blade damage
during assembly
Settings
One surgeon: Dr. J. C. Vryghem Private clinic: Brussels Eye Doctors Wavelight Allegreto laser for excimer ablation
Prospective study in 68 eyes of 34 patients 2 months in 2007
One Use Plus with 130 head and metal ring
Methods
Flap thickness by subtractive pachymetry Flap dimensions measured with calipers Complications reported intraop and postop
One Use Plus with 130 head and metal ring
Results Flap Thickness
• Microkeratome head
• Speed
• Average Thickness
• Range
130 µ
2 (Fast)
123 +/- 12 µ
97 to 149 µ
One Use Plus with 130 head and metal ring
Results Flap Thicknessversus Preop pachymetry
80
90
100
110
120
130
140
150
160
170
180
450 475 500 525 550 575 600 625 650
Preop pachymetry (microns) n =68
Fla
p th
ickn
ess
(mic
rons
)
9.9 mm ± 0.25 min 9.0
max 10.25
Flap Diameter
Results Vertical Flap DiameterHinge size
One Use Plus with 130 head and metal ring
5.11 mm ± 0.56 min 4
max 6.5
Hinge size
Results Complications
• Button-hole• Free cap• Irregular flap• Thin flap requiring BCL• Epithelial sloughing• DLK• Epithelial ingrowth• Microstriae• Bleeding
0
0
0
0
3
0
0
25
n = 68
Results Flap and bed quality
• Centration 95 % excellent
• Edge quality 60 % excellent
• Shape of the flap 100 % excellent
• Bed quality 96 % excellent
28/68 eyes
Conclusion
My keratome of choice in LASIK Excellent flap thickness predictability Excellent safety profile
Ongoing study with 90 Head
Moria One Use Plus with metal head