Femtosecond laser in laser in situ keratomileusis

Abstract

Flap creation is a critical step in laser in situ keratomileusis (LASIK). Efforts to improve the safety and predictability of the lamellar incision have fostered the development of femtosecond lasers. Several advantages of the femtosecond laser over mechanical microkeratomes have been reported in LASIK surgery. In this article, we review common considerations in management and complications of this step in femtosecond laser-LASIK and concentrate primarily on the IntraLase laser because most published studies relate to this instrument.

Figure 1

Slitlamp photograph showing trace interface haze after ultrathin-flap (90 μm) femtosecond laser LASIK. Although the patient had no decrease in CDVA, a light-scattering test (C-Quant) was abnormal in the eye (courtesy of Karolinne M. Rocha, MD).

Figure 2

Diffuse OBL 5 minutes after flap creation using the IntraLase 60 kHz femtosecond laser. Over 35 minutes, all the bubbles were cleared from the cornea and refractive ablation was performed with no interference with the tracking system of the excimer laser.

Figure 3

Slitlamp documentation of severe punctate epithelial erosions (arrows) in the cornea of an eye that developed LASIK-induced neurotrophic epitheliopathy 1 week after surgery. The epitheliopathy involved the pupillary area, and there was some decrease in CDVA, which resolved 6 months after surgery.