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Evaluation of the Optimal Microkeratome Setting for a Minimal Deviation from Intended Flap Thickness
1Tehrani M., 1Hoffmann S., 2Krummenauer F., 1Frisch L. H. J., 1Dick H. B.,
1Johannes-Gutenberg-Universität Mainz, Universitäts-Augenklinik (Mainz)
2Johannes-Gutenberg-Universität Mainz, Koordinierungszentrum für Klinische Studien (KKS) (Mainz)
Purpose: To compare flap quality and thickness in an experimental setting using the Amadeus (Allergan) and Carriazo/Barraquer microkeratome for laser in situ keratomileusis.
Methods: 135 eyes were cut using the Amadeus microkeratome with various settings (head advance, oscillation rate), 29 using the Carriazo/Barraquer microkeratome. Flap diameter and hinge width were measured by planimetry and flap thickness by ultrasound pachymetry. All flaps were evaluated with light and scanning electron microscopy.
Results: Various oscillation rates and head advance led to significant differences in flap parameter (thickness, diameter, hinge width). Optimal cut quality was achieved with 1 mm/sec head advance and 8000 rpm in the Amadeus microkeratome. With this setting least target deviation in flap thickness was obtained (mean: 169,4 µm, target: 160 µm, standard deviation: 15.6 µm) if compared to the Carriazo/Barraquer microkeratome. The Amadeus microkeratome demonstrated a statistically significant lower deviation from the target thickness (p< 0.01) and lower range.
Conclusion: Optimisation of microkeratome settings leads to minimize deviation from target thickness and improved parameter. The Amadeus microkeratome achieved a statistically significant lower deviation in flap thickness than the Carriazo/Barraquer microkeratome. Individualisation of the microkeratome settings may help to decrease flap complications and improve refractive outcome.