In vivo corneal confocal microscopy comparison of intralase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis.
OBJECTIVE
To assess and compare corneal modifications induced by IntraLase PulsionFS femtosecond laser and mechanical microkeratome Hansatome for laser in situ keratomileusis (LASIK) using the new-generation Heidelberg Retina Tomograph II (HRT II)/Rostock Cornea Module confocal microscope.


METHODS
In this case-control study, 24 eyes of 12 patients were examined with the HRT II in the follow-up of IntraLase femtosecond laser for LASIK myopic surgery. Twenty eyes of 10 patients were also examined after microkeratome Hansatome-LASIK surgery. In both groups, the patients underwent the first follow-up examination on day 7 and the last 12 months after surgery. Morphologic modifications of corneal architecture were evaluated, and comparisons were made between the two flap-formation techniques.


RESULTS
Evaluation of both groups on day 7 showed keratocyte transformation, most likely related to cellular activation beneath the interface. The flap margin after the IntraLase technique appeared microscopically as a clear-cut edge that included the epithelial plug. At month 2, secondary fibrosis, adjacent to the still well-defined IntraLase flap edge, was observed. This reaction diminished with time, leaving a fibrotic scar adjacent to a wound constriction originating from the surrounding stroma. The flap margin of the mechanical microkeratome had the appearance of a less clearly identified fibrotic scar with no epithelial plug.


CONCLUSIONS
This study reveals morphologic similarities between the interfaces obtained by femtosecond laser and mechanical microkeratome, probably because the same excimer laser performed the photoablation. However, the IntraLase flap margin showed greater fibrotic scarring than that induced by the mechanical microkeratome.
Sonigo
Bertrand
B
Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, and Assistance Publique des Hopitaux de Paris, School of Medicine, University of Versailles, France.
Iordanidou
Vasiliki
V
Chong-Sit
Didier
D
Auclin
Francois
F
Ancel
Jean Marc
JM
Labbé
Antoine
A
Baudouin
Christophe
C
D000328:Adult; D003315:Cornea / Q000294:innervation / Q000473:pathology* / Q000601:surgery; D003319:Corneal Stroma / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology; D019573:Epithelium, Corneal / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D008297:Male; D033401:Microscopy, Acoustic; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers; D009416:Nerve Regeneration / Q000502:physiology; D012030:Refractive Errors / Q000473:pathology; D054140:Refractive Surgical Procedures; D013524:Surgical Flaps; D014276:Trigeminal Nerve / Q000502:physiology