Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis

Jens Heichel,1 Frank Wilhelm,2 Kathleen S Kunert,3 Rabea Schlueter,4 Ute Stuhltraeger,1 Thomas Hammer5 1Department of Ophthalmology, University Hospital of Martin Luther University Halle/Wittenberg, Halle (Saale), Germany; 2Augen im Zentrum, Greifswald, Germany; 3Department of Ophthalmology, Helios...

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Autores principales:	Heichel J, Wilhelm F, Kunert KS, Schlueter R, Stuhltraeger U, Hammer T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/7546aad27451417cb9b3c70a77ffabb2
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spelling	oai:doaj.org-article:7546aad27451417cb9b3c70a77ffabb22021-12-02T02:48:00ZInfluence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis1177-5483https://doaj.org/article/7546aad27451417cb9b3c70a77ffabb22013-12-01T00:00:00Zhttp://www.dovepress.com/influence-of-microkeratome-parameters-on-the-stromal-bed-and-flap-edge-a15305https://doaj.org/toc/1177-5483 Jens Heichel,1 Frank Wilhelm,2 Kathleen S Kunert,3 Rabea Schlueter,4 Ute Stuhltraeger,1 Thomas Hammer5 1Department of Ophthalmology, University Hospital of Martin Luther University Halle/Wittenberg, Halle (Saale), Germany; 2Augen im Zentrum, Greifswald, Germany; 3Department of Ophthalmology, Helios Klinikum Erfurt, Erfurt, Germany; 4Institute of Microbiology, Ernst-Moritz-Arndt-University, Greifswald, Germany; 5Augenzentrum Frohe Zukunft, Halle (Saale), Germany Purpose: Femtosecond lasers have become the standard for laser-assisted in situ keratomileusis (LASIK) flap creation, but advanced mechanical microkeratomes are still an alternative, more cost-effective way to create the flap. The SCHWIND Carriazo-Pendular microkeratome is one of the most commonly used microkeratomes. The influence of different cutting parameters (head-advance speeds, cutting heads) on morphology of LASIK cuts was investigated. Setting: Experimental study performed at the University Eye Hospital of the Martin Luther University Halle/Wittenberg, Halle (Saale), Germany. Methods: The Carriazo-Pendular microkeratome was used on freshly enucleated porcine eyes for lamellar keratotomy. After flap removal, the cutting edge and stromal bed were evaluated from scanning electron micrographs using an individualized scoring system. Four different settings of microkeratome parameters were compared. For each setting, eight cuts were evaluated (n=32). Results: Different oscillation frequencies and head-advance speeds did not influence the cutting qualities. A higher oscillation/feed rate ratio seemed to be advantageous for a smoother interface. Concerning different cuttings heads, a deeper keratotomy led to sharper cutting edges. The thinner the flap, the more irregularities in the stromal bed appeared. Complications did not occur. Conclusion: The Carriazo-Pendular microkeratome is a safe tool with which to create a LASIK flap and is a good alternative to a costly femtosecond laser. Deeper keratotomies, as well as the use of a higher oscillation/feed rate quotient, improve the cutting quality. Keywords: laser-assisted in situ keratomileusis (LASIK), microkeratome, stromal bed quality, surface regularity, Descemet's stripping automated endothelial keratoplasty (DSAEK), scanning electron microscopy (SEM)Heichel JWilhelm FKunert KSSchlueter RStuhltraeger UHammer TDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 61-69 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Heichel J Wilhelm F Kunert KS Schlueter R Stuhltraeger U Hammer T Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
description	Jens Heichel,1 Frank Wilhelm,2 Kathleen S Kunert,3 Rabea Schlueter,4 Ute Stuhltraeger,1 Thomas Hammer5 1Department of Ophthalmology, University Hospital of Martin Luther University Halle/Wittenberg, Halle (Saale), Germany; 2Augen im Zentrum, Greifswald, Germany; 3Department of Ophthalmology, Helios Klinikum Erfurt, Erfurt, Germany; 4Institute of Microbiology, Ernst-Moritz-Arndt-University, Greifswald, Germany; 5Augenzentrum Frohe Zukunft, Halle (Saale), Germany Purpose: Femtosecond lasers have become the standard for laser-assisted in situ keratomileusis (LASIK) flap creation, but advanced mechanical microkeratomes are still an alternative, more cost-effective way to create the flap. The SCHWIND Carriazo-Pendular microkeratome is one of the most commonly used microkeratomes. The influence of different cutting parameters (head-advance speeds, cutting heads) on morphology of LASIK cuts was investigated. Setting: Experimental study performed at the University Eye Hospital of the Martin Luther University Halle/Wittenberg, Halle (Saale), Germany. Methods: The Carriazo-Pendular microkeratome was used on freshly enucleated porcine eyes for lamellar keratotomy. After flap removal, the cutting edge and stromal bed were evaluated from scanning electron micrographs using an individualized scoring system. Four different settings of microkeratome parameters were compared. For each setting, eight cuts were evaluated (n=32). Results: Different oscillation frequencies and head-advance speeds did not influence the cutting qualities. A higher oscillation/feed rate ratio seemed to be advantageous for a smoother interface. Concerning different cuttings heads, a deeper keratotomy led to sharper cutting edges. The thinner the flap, the more irregularities in the stromal bed appeared. Complications did not occur. Conclusion: The Carriazo-Pendular microkeratome is a safe tool with which to create a LASIK flap and is a good alternative to a costly femtosecond laser. Deeper keratotomies, as well as the use of a higher oscillation/feed rate quotient, improve the cutting quality. Keywords: laser-assisted in situ keratomileusis (LASIK), microkeratome, stromal bed quality, surface regularity, Descemet's stripping automated endothelial keratoplasty (DSAEK), scanning electron microscopy (SEM)
format	article
author	Heichel J Wilhelm F Kunert KS Schlueter R Stuhltraeger U Hammer T
author_facet	Heichel J Wilhelm F Kunert KS Schlueter R Stuhltraeger U Hammer T
author_sort	Heichel J
title	Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
title_short	Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
title_full	Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
title_fullStr	Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
title_full_unstemmed	Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
title_sort	influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/7546aad27451417cb9b3c70a77ffabb2
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Influence of microkeratome parameters on the stromal bed and flap edge quality in laser in situ keratomileusis

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