title: Separate effects of the microkeratome incision and laser ablation on the eye's wave aberration.
abstract: OBJECTIVE
  To study the optical changes induced by the microkeratome cut, the subsequent laser ablation, and the biomechanical healing response of the cornea in normal laser in situ keratomileusis (LASIK) eyes.
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  A Hansatome microkeratome was used to cut a corneal flap in one eye (study eye) of 17 normal myopic patients and a subsequent laser ablation was performed 2 months after this initial microkeratome incision. Control eyes received conventional LASIK treatments at the latter time point. The wave aberration of both the study and contralateral control eyes were measured over a 6-mm pupil with a Shack-Hartmann wavefront sensor for all preoperative, postflap cut, and postablation visits.
  
  
  RESULTS
  The eye's higher order aberrations had a small, but significant increase (P =.03) of approximately 30% 2 months after cutting a flap. No systematic changes were observed in nearly all Zernike coefficients from their preoperative levels at 2 months postflap cut. A significant difference between the study and control eyes was observed for one trefoil mode, Z(3)(3) (P =.04).
  
  
  CONCLUSIONS
  There was a wide variation in the response of individual Zernike modes across patients after cutting a flap. The majority of spherical aberration induced by the LASIK procedure seems to be due to the laser ablation and not the microkeratome cut. In addition, the total and higher order root mean square of wavefront errors were nearly identical for both the study and control eyes 3-months after the laser ablation, indicating that a procedure in which the incision and the ablation are separated in time to better control aberrations does not compromise the outcome of a conventional LASIK treatment.
authors.affiliation: The Institute of Optics, University of Rochester, Rochester, NY, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Porter
authors.forename: Scott
authors.initials: S
authors.lastname: MacRae
authors.forename: Geunyoung
authors.initials: G
authors.lastname: Yoon
authors.forename: Cynthia
authors.initials: C
authors.lastname: Roberts
authors.forename: Ian G
authors.initials: IG
authors.lastname: Cox
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology*; D019781:Corneal Topography; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps / Q000009:adverse effects*; D014786:Vision Disorders / Q000209:etiology* / Q000473:pathology; D014945:Wound Healing