Moataz M Sabry MD PhD Moataz M. Sabry, MD, PhD.

–5/31/2010
Moataz M.
M Sabry,
Sabry MD,
MD PhD
PhD.
Ophthalmology Department,Tanta University, Egypt
Evaluation of Mechanical
Microkeratomes
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Evaluation of Mechanical
Microkeratomes
SHOULD WE ABONDONE
MECHANICAL
MICROKERATOMES?
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With Mechanical Microkeratomes, LASIK
is a one-laser procedure, there’s no
moving of patient or furniture to get from
one laser to the next.
Evaluation of Mechanical
Microkeratomes
Mechanical Microkeratomes can be used
with all types of Excimer Laser Systems.
(NOT with Femtosecond Lasers)
Evaluation of Mechanical
Microkeratomes
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Mechanical Microkeratomes are faster.
More comfortable to the patient.
Less drying of the eye, which can affect the
procedure.
accuracyy of the laser p
Evaluation of Mechanical
Microkeratomes
Less Suction Time with Mechanical
Microkeratomes (10-15 seconds) compared
to one minute or more with Femtosecond
Lasers.
L
Less
Incidence
I id
off suction
ti lloss compared
d tto
femtosecond lasers.
Evaluation of Mechanical
Microkeratomes
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With Mechanical Microkeratomes,
there is no need to do manual
dissection of the flap which carries a
risk of flap tears and disrupts the
stromal surface.
surface
Evaluation of Mechanical
Microkeratomes
Renee Solomon (M.D., Long Island, N.Y.),
compared the flap creations of femtosecond
laser vs. mechanical microkeratome.
The stromal beds of the mechanical
microkeratome and the femtosecond
keratome were compared.
Evaluation of Mechanical
Microkeratomes
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MECHANICAL
Stromal bed has mild areas of surface
irregularity with significant smooth areas.
Individual keratocytes can be visualized.
FEMTOSECOND
Stromal bed appears to have
course spongelike appearance with
multiple crevices and irregularities.
Evaluation of Mechanical
Microkeratomes
OUP-SBK
Intralase 60 khz
Scanning EM x20
After cutting a flap with an intended flap thickness of 100 microns
Evaluation of Mechanical
Microkeratomes
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Femtosecond Lasers can create thin planner
flaps for Sub-Bowman
Sub Bowman Keratomileusis
however Mechanical Microkeratomes can
create thin flaps with the use of different
heads and with the One Use Plus-SBK from
Moria we can get thin and planner flaps
comparable to those obtained by
femtosecond lasers.
Evaluation of Mechanical
Microkeratomes
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Osama Ibrahim, MD, ESCRS winter 2009
Courtesy of James S. Lewis, MD. Elkins Park, PA, USA
Osama Ibrahim, MD, ESCRS winter 2009
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Osama Ibrahim, MD, ESCRS winter 2009
Osama Ibrahim, MD, ESCRS winter 2009
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Mechanical Microkeratomes can
mechanically create an epithelial flap
(Epi-LASIK) for surface ablation.
Evaluation of Mechanical
Microkeratomes
Mechanical Microkeratomes offer a rapid
visual recovery post-operative compared
to Femtosecond Lasers that lacks the
(wow factor) of early visual recovery*.
*Donnenfeld ED. FS laser: Not ready for prime time. Ophthalmology Management. 200;8(suppl):10-12.
Woodhams TJ. Does a better flap improve outcomes? Ophthalmology Management.2004;(suppl):7-9.
Evaluation of Mechanical
Microkeratomes
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Osama Ibrahim, MD Pre ESCRS 2008 meeting, Berlin
Osama Ibrahim, MD Pre ESCRS 2008 meeting, Berlin
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There are no statistically
Th
i i ll significant
i ifi
difference in postoperative vision or higher
order aberrations found in direct comparison
of Mechanical Microkeratomes with
Femtosecond Lasers*.
*Kezirian GM, Stonecipher KG. Comparison of the IntraLase femtosecond laser and
mechanical keratomes for laser in situ keratomileusis. J Cataract Refract Surg. 2004;30:804811.
1
09
0.9
Hansatome
Intralase
Evaluation of Mechanical
Microkeratomes
99%
98%
Percent of Patients
0.8
0.7
0.6
66%
67%
0.5
0.4
0.3
0.2
0.1
0
20/20 or better
20/40 or better
*Kezirian GM, Stonecipher KG. Comparison of the IntraLase femtosecond laser and mechanical keratomes
for laser in situ keratomileusis. J Cataract Refract Surg. 2004;30:804-811.
Evaluation of Mechanical
Microkeratomes
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Patients mayy experience
p
slightly
g y more
postoperative discomfort with IntraLASIK
than with mechanical LASIK, Because the
FS laser’s flap is created by the removal of
tissue within the stroma and around its
circumference thus the flap is smaller than
the stromal bed*.
*Donnenfeld ED. FS laser: Not ready for prime time. Ophthalmology Management. 200;8(suppl):10-12.
Goldberg DB. The IntraLASIK learning curve. Cataract & Refractive Surgery Today. 2004;4:24-428.
Evaluation of Mechanical
Microkeratomes
Osama Ibrahim, MD Pre ESCRS 2008 meeting, Berlin
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Osama Ibrahim, MD Pre ESCRS 2008 meeting, Berlin
Mechanical
Femtosecond
Evaluation of Mechanical
Microkeratomes
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Evaluation of Mechanical
Microkeratomes
The diff
Th
difference iin size
i b
between
t
th
the flap
fl and
d
the stromal bed with femtosecond lasers can
result in the occurrence of post-operative flap
folds that need (reseating) and may resist
treatment by flap repositioning*.
*Biser SA, Bloom AH, Donnenfeld ED. Flap folds after femtosecond LASIK. Eye Contact
Lens. 2003;29:252-254.
Evaluation of Mechanical
Microkeratomes
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Flap lift for retreatment is much easier for
flaps created with Mechanical
Microkeratomes than those created with
Femtosecond Lasers due to tight adhesions
between the flap and the bed specially at the
fl edge.
flap
d
Evaluation of Mechanical
Microkeratomes
Evaluation of Mechanical
Microkeratomes
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Although the incidence of complications is
lower with Femtosecond Lasers compared to
Mechanical Microkeratomes, we should
keep in mind that Intra-LASIK is a safe but
not a risk-free
risk free procedure
procedure.
Evaluation of Mechanical
Microkeratomes
1
Intralase Flap
C
Complications
li ti
09
0.9
Percent of Patients
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0.12
Suction
Loss
0.09
Button Hole
0.05
Irregular
Cut
0.05
Bubble in
AC
0.05
Incomplete
Cut
0.04
Thin Flap
0.03
0.03
Flap Tear
*Menthyie Onder, MD. Complications and management of IntraLasik. Presented at Instituto di recovero e cura
carettere scientifico 2006.
Epithelial
Defect
Evaluation of Mechanical
Microkeratomes
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Evaluation of Mechanical
Microkeratomes
Moria One Use-Plus SBK compared to Femtosecond lasers in this flap LASIK (SBK).
Roundtable discussion 2009
Evaluation of Mechanical
Microkeratomes
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Mechanical Microkeratomes have less
incidence of post-operative flap interface
inflammation (DLK) compared to
Femtosecond Lasers.
Although changing the laser parameters
may be sufficient to address this problem
specially with the new generations.
Evaluation of Mechanical
Microkeratomes
Evaluation of Mechanical
Microkeratomes
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100
90
Percent of Patients
80
70
60
Mechanical
Intralase
50
40
30
20
10
11.07
3
0
DLK
*Menthyie Onder, MD. Complications and management of IntraLasik. Presented at Instituto di recovero e cura
carettere scientifico 2006.
Evaluation of Mechanical
Microkeratomes
A unique
i
postoperative
i complication
li i ffor
Femtosecond Lasers that has not been
faced with Mechanical Microkeratomes is
Track Related Irido
Irido-Cyclitis
Cyclitis and
Scleritis
Evaluation of Mechanical
Microkeratomes
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This syndrome consists of debilitating
photophobia with good vision and no clinical
signs.
The syndrome is the result of inflammatory
cytokines being produced in a track created by
the FS laser between the LASIK flap interface
and the sclera that allows the cytokines to pass
to the perilimbal sclera and iris base*.
*Will BR. Track-related iridocyclitis and scleritis associated with use of the IntraLase for LASIK.
Paper presented at: The ASCRS/ASOA Symposium on Cataract, IOL, and Refractive Surgery;
May4, 2004; San Diego, CA.
Evaluation of Mechanical
Microkeratomes
Obvious Bubble Layer (OBL) is another
unique finding with Femtosecond Laser
which is not seen with Mechanical
Microkeratomes and sometimes there is
bursting of air bubbles into AC resulting in
diffi lt tracking
difficult
t ki and
d iris
i i registration
i t ti failure
f il
during excimer laser ablation.
Evaluation of Mechanical
Microkeratomes
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Mechanical Microkeratomes
 One Laser Procedure
Procedure.
 Used with any Laser.
 Faster.
 Less Drying.
 Less suction time.
 No Manual Dissection of flap.
Mechanical Microkeratomes
 Create thin flap and epithelial flap.
flap
 Safer with superficial opacities.
 Safer with previous RK.
 Rapid visual recovery.
 Less incidence of DLK.
 Easier flap lift for retreatment.
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The costt off iinitial
Th
iti l acquisition
i iti and
d annuall
service of Femtosecond Laser is almost 6
folds that of a Mechanical Microkeratome.
The Disposable single use cost of
Femtosecond laser for flap creation is
almost two and half folds that of a
Mechanical Microkeratome.
Evaluation of Mechanical
Microkeratomes
Femto-LASIK Center
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Moria One Use-Plus SBK compared to Femtosecond lasers in this flap LASIK (SBK).
Roundtable discussion 2009
Evaluation of Mechanical
Microkeratomes
Thank You
Evaluation of Mechanical
Microkeratomes
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