Microkeratome versus femtosecond flaps: accuracy and complications.
OBJECTIVE
To update the knowledge on differences between mechanical microkeratome and femtosecond flaps for laser in-situ keratomileusis (LASIK) in terms of accuracy and complications.


RESULTS
Corneal flaps created with the femtosecond laser present a more planar architecture and provide greater precision in flap diameter and thickness; a more uniform flap thickness across the flap diameter and it allows the surgeon to programme the angulation of the flap periphery. Femtosecond LASIK flaps are classically related to complications derived from a more intense inflammatory response, such as diffuse lamellar keratitis and transient light-sensitivity syndrome. Newer femtosecond models allow for much lower energy delivery to cut the flap, to the point the overall inflammatory response is not significantly different from the microkeratome. The incidence of complications such as epithelial defect and flap dislocations is higher with microkeratome flaps.


CONCLUSIONS
This review examines the accuracy and complications of flaps created with femtosecond and microkeratome. Both femtosecond and microkeratome are able to create accurate LASIK flaps. Femtosecond LASIK flaps represent significant improvement in morphology and predictability with implications for safety.
aDepartment of Ophthalmology at University of Sao Paulo bDepartment of Ophthalmology at Federal University of Rio de Janeiro, Sao Paulo, Brazil cMedical University of South Carolina, and Magill Vision Center, Charleston, South Carolina, USA.
Marcony R
MR
Santhiago
Newton
N
Kara-Junior
George O
GO
Waring
D003319:Corneal Stroma / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D011183:Postoperative Complications; D015203:Reproducibility of Results; D013524:Surgical Flaps