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. 2021 Mar 18;14(3):430-435.
doi: 10.18240/ijo.2021.03.16. eCollection 2021.

Comparison of healing patterns of different side-cut angulations after FS-LASIK

Wei Wei  1 , Xi-Yu Sun  1 , Di Shen  1 , Xiao-Rui Wang  1 , Yu-Qiang Ji  1 , Chang-Ning Zhang  1
Affiliations

Comparison of healing patterns of different side-cut angulations after FS-LASIK

Wei Wei et al. Int J Ophthalmol. .

Abstract

Aim: To investigate and evaluate healing patterns around flaps made with different side-cut angulations after femtosecond laser in situ keratomileusis (FS-LASIK).

Methods: Thirty-four patients (68 eyes) received a 90° side-cut (n=34) or a 120° side-cut flaps (n=34) made with a femtosecond laser. One day, 1wk, 1 and 3mo postoperatively, side-cut scar was evaluated under slit-lamp photography according to a new grading system (Grade 0=transparent scar, 1=faint healing opacity, and 2=evident healing opacity). In vivo corneal confocal microscopy and anterior segment optical coherence tomography (AS-OCT) were used to observe wound-healing patterns around flap margin in the two groups. Sirius Scheimpflug Analyzer was also used to analyze higher order aberrations 3mo after surgery.

Results: There were no significant differences in flap wound-healing patterns at each follow up between the two groups (P>0.05). Three months after surgery, the flap edge scar classified as Grade 0 had excellent apposition and rapid nerve regeneration. At 3 mm and 5 mm pupil diameters, there were significant differences in trefoil aberrations between the two groups (P<0.05), but no statistically significant differences were found in total higher order aberrations (HOAs), spherical aberrations or coma in any of the pupil size conditions (P>0.05).

Conclusion: Flap edge scars classified as Grade 0 have excellent apposition and rapid nerve regeneration, and 120° side-cut angle flaps induce less trefoil aberrations after FS-LASIK.

Keywords: confocal microscopy; femtosecond laser; healing; scar; side-cut.

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Figures

Figure 1
Figure 1. The grading was performed as observed and registered photographically by slit lamp photography
A: Grade 0: Transparent scar; B: Grade 1: Faint healing opacity; C: Grade 2: Evident healing opacity.
Figure 2
Figure 2. Bilateral eye comparison of one patient
Both corneas were classified as Grade 0. A: The flap was created using a 90° side-cut angle; B: The flap was created using a 120° side-cut angle.
Figure 3
Figure 3. Bilateral eye comparison of the same patient
Both corneal flaps were classified as Grade 0. A: 90° side-cut angle wound margin; B: 120° side-cut angle wound margin showed excellent apposition, and subbasal nerve regeneration was observed.
Figure 4
Figure 4. Bilateral eye comparison of another patient
Both corneal flaps were classified as Grade 2. Evident hypercellular fibrotic stromal scaring around the wound and an epithelial plug in the wound gap was observed; no nerve regeneration was found. Because the morphology of scar under slit-lamp of bilateral eyes was similar, only the right eye was examined by IVCM to show wound-healing patterns.
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