Reproducibility of LASIK flap thickness using the Hansatome microkeratome.
OBJECTIVE
To evaluate the actual versus the expected thickness of laser in situ keratomileusis (LASIK) flaps and to determine the factors that affect flap thickness.


METHODS
Centre For Sight, Queen Victoria Hospital, East Grinstead, United Kingdom.


METHODS
A retrospective analysis of LASIK procedures in 757 consecutive eyes was done. The surgery was performed by a single surgeon using 2 Hansatome microkeratomes (Bausch & Lomb) with 160 microm and 180 microm heads. Patient age, preoperative manifest refraction, automated keratometry, preoperative central pachymetry, and intraoperative stromal pachymetry were evaluated to determine whether they influenced the actual flap thickness.


RESULTS
Bilateral LASIK was performed in 343 patients (686 eyes). The 160 microm head was used in 641 eyes (84.6%) (Group 1) and the 180 microm head, in 116 eyes (15.4%) (Group 2). The mean preoperative manifest refraction spherical equivalent (SE) was -3.9 diopters (D) +/- 4.5 (SD) (range +7.4 to -25.0 D) in Group 1 and -4.4 +/- 3.7 D (range +7.1 to -12.9 D) in Group 2. The mean preoperative keratometry reading was 43.6 +/- 1.8 D (range 36.0 to 48.6 D) and 43.6 +/- 1.8 D (range 35.9 to 47.0 D), respectively; the mean preoperative central pachymetry was 543 +/- 35 microm (range 447 to 643 microm) and 548 +/- 31 microm (range 453 to 613 microm), respectively; and the mean flap thickness was 116.4 +/- 19.8 microm and 117.3 +/- 18.0 microm, respectively. The difference between the actual and the expected flap thickness in each group was statistically significant (P<.001). There was no significant difference in the actual flap thickness between the 2 Hansatomes. The preoperative SE and central pachymetry were the only factors that influenced the actual flap thickness (P<.05); thin flaps were more common with increasing myopia and increasing corneal thickness.


CONCLUSIONS
Spherical equivalent and preoperative pachymetry were the principal factors that influenced flap thickness. Preoperative keratometry values and patient age did not influence the actual flap thickness.
Giledi
Osama
O
Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, United Kingdom.
Mulhern
Mark G
MG
Espinosa
Marcela
M
Kerr
Andrea
A
Daya
Sheraz M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001837:Body Weights and Measures; D003319:Corneal Stroma / Q000473:pathology*; D019781:Corneal Topography; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000592:standards*; D008875:Middle Aged; D054140:Refractive Surgical Procedures; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000473:pathology*