title: Flap-induced and laser-induced ocular aberrations in a two-step LASIK procedure.
abstract: OBJECTIVE
  To identify aberrations created by making a laser in situ keratomileusis (LASIK) flap and treating the refractive error with laser ablation at a later date.
  
  
  METHODS
  Twenty-two eyes (11 patients) underwent a two-step LASIK procedure with the Alcon LADAR-Vision laser (Alcon Laboratories, Ft Worth, Tex). In the first step, a flap was created, and 1 month later the flap was lifted and laser ablation performed. Aberrations were measured with the LADARWave wavefront measurement device preoperatively, after making the flap (1 day, 1 week, 1 month) and after laser treatment (1 week and 3 months). Two different microkeratomes were used (Moria M2 [Moria; Antony, France] and SKBM [Alcon]). With the SKBM, all flap hinges were nasal; with the Moria M2, the flap hinge was randomly selected as superior in one eye and nasal in the other.
  
  
  RESULTS
  A slight hyperopic shift was seen in the manifest and wavefront refractions at 1 week and 1 month after flap creation for the Moria M2, but not for the SKBM. Statistically significant change in manifest sphere with the Moria M2 showed a mean shift at 1 month of +0.50 +/- 0.08 diopters (D) whereas the SKBM showed no mean shift, but less reproducibility, +0.06 +/- 0.17 D. Higher order aberrations after flap creation were statistically significantly higher for all except coma with both microkeratomes, but with no predictable trends observed. Although higher in magnitude, post flap aberrations were less than one quarter the increase noted in post laser aberrations, except for "other terms."
  
  
  CONCLUSIONS
  Creating a LASIK flap induces changes in lower and higher order ocular aberrations. The change in lower order terms is microkeratome dependent. Higher order aberrations increase to a much larger degree after laser than after flap, making a two-step procedure unnecessary in conventional LASIK.
authors.affiliation: Department of Refractive Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland 44195, Ohio, USA.
authors.forename: Samra
authors.initials: S
authors.lastname: Waheed
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Chalita
authors.forename: Meng
authors.initials: M
authors.lastname: Xu
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Krueger
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000175:diagnosis / Q000209:etiology*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis / Q000209:etiology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D011446:Prospective Studies; D012029:Refraction, Ocular; D013524:Surgical Flaps / Q000009:adverse effects*; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology*; D014792:Visual Acuity