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      Comparison of DLK incidence after laser in situ keratomileusis associated with two femtosecond lasers: Femto LDV and IntraLase FS60

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          Abstract

          Purpose

          To compare the incidence of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) with flap creation using the Femto LDV and IntraLase™ FS60 femtosecond lasers.0

          Methods

          A total of 818 consecutive myopic eyes had LASIK performed using either Femto LDV or IntraLase FS60 for flap creation. The same excimer laser, the Allegretto Wave® Eye-Q Laser, was used for correcting refractive errors for all patients. In the preoperative examination, uncorrected distance visual acuity, corrected distance visual acuity, and manifest refraction spherical equivalent were measured. At the postop examination, the same examinations were performed along with a slit-lamp biomicroscopic examination, and patients with DLK were classified into stages. For the statistical analysis of the DLK occurrence rate and the visual and refractive outcomes, the Mann-Whitney’s U-test was used.

          Results

          In the Femto LDV group with 514 eyes, 42 (8.17%) had DLK. In the IntraLase FS60 group with 304 eyes, 114 (37.5%) had DLK. There was a statistically significant difference in the DLK incidence rate between these groups ( P < 0.0001). Both groups had excellent visual and refractive outcomes. Although low levels of DLK were observed for both groups, they did not affect visual acuity.

          Conclusion

          While there were significantly fewer incidences of low level DLK when using Femto LDV, neither femtosecond laser induced high levels of DLK, and any postoperative DLK cleared up within 1 week. Therefore, both lasers provide excellent results, with no clinical differences, and both excel at flap creation for LASIK.

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          Most cited references29

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          Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis.

          To compare laser in situ keratomileusis (LASIK) results obtained with the femtosecond laser (IntraLase Corp.) to those obtained using 2 popular mechanical microkeratomes. Private practice, Greensboro, North Carolina, USA. This retrospective analysis compared LASIK outcomes with the femtosecond laser to those with the Carriazo-Barraquer (CB) microkeratome (Moria, Inc.) and the Hansatome microkeratome (Bausch & Lomb, Inc.). The 3 groups were matched for enrollment criteria and were operated on under similar conditions by the same surgeon. There were 106 eyes in the IntraLase group, 126 eyes in the CB group, and 143 eyes in the Hansatome group. One day postoperatively, the uncorrected visual acuity (UCVA) results in the 3 groups were similar; at 3 months, the UCVA and the best spectacle-corrected visual acuity results were not significantly different. A manifest spheroequivalent of +/-0.50 diopter (D) was achieved in 91% of eyes in the IntraLase group, 73% of eyes in the CB group, and 74% of eyes in the Hansatome group (P<.01). IntraLase flaps were significantly thinner (P<.01) and varied less in thickness (P<.01) than flaps created with the other devices. The mean flap thickness was 114 microm +/- 14 (SD) with the IntraLase programmed for a 130 microm depth, 153 +/- 26 microm with the CB using a 130 microm plate, and 156 +/- 29 microm with the Hansatome using a 180 microm plate. Loose epithelium was encountered in 9.6% of eyes in the CB group and 7.7% of eyes in the Hansatome group but in no eye in the IntraLase group (P =.001). Surgically induced astigmatism in sphere corrections was significantly less with the IntraLase than with the other devices (P<.01). The IntraLase demonstrated more predictable flap thickness, better astigmatic neutrality, and decreased epithelial injury than 2 popular mechanical microkeratomes.
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            Dry eye associated with laser in situ keratomileusis: Mechanical microkeratome versus femtosecond laser.

            To compare the incidence of laser in situ keratomileusis (LASIK)-associated dry eye and the need for postoperative cyclosporine A treatment after flap creation with a femtosecond laser and a mechanical microkeratome. Cole Eye Institute, Cleveland, Ohio, USA. Eyes were randomized to flap creation with an IntraLase femtosecond laser (30 or 60 kHz) or a Hansatome microkeratome. No patient had signs, symptoms, or treatment of dry eye preoperatively. Flap thickness was determined by intraoperative ultrasonic pachymetry. Slitlamp assessments of the cornea and need for postoperative dry-eye treatment were evaluated preoperatively and 1 month postoperatively. The flap was created with the femtosecond laser in 113 eyes and with the microkeratome in 70 eyes. The difference in mean central flap thickness between the femtosecond group (111 mum +/- 14 [SD]) and the microkeratome group (131 +/- 25 mum) was statistically significant (P<.001). The incidence of LASIK-associated dry eye was statistically significantly higher in the microkeratome group (46%) than in the femtosecond group (8%) (P<.0001), as was the need for postoperative cyclosporine A treatment (24% and 7%, respectively) (P<.01). In the microkeratome group, there was no correlation between thick flaps and a higher incidence of LASIK-induced dry eye. Eyes with femtosecond flaps had a lower incidence of LASIK-associated dry eye and required less treatment for the disorder. In addition to neurotrophic effects from corneal nerve cutting, other factors may be important because no correlation was found between flap thickness (or ablation depth) and the incidence of LASIK-induced dry eye.
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              Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison.

              To compare the incidence of flap complications after creation of laser in situ keratomileusis (LASIK) flaps using a zero-compression microkeratome or a femtosecond laser. John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. Evidence-based manuscript. The flap complication rate was evaluated during the initial 18 months of experience using a zero-compression microkeratome (Hansatome) or a femtosecond laser (IntraLase FS60) for flap creation. The flap complication rate was 14.2% in the microkeratome group and 15.2% in the femtosecond laser group (P = .5437). The intraoperative flap complication rate was 5.3% and 2.9%, respectively (P = .0111), and the postoperative flap complication rate, 8.9% and 12.3%, respectively (P = .0201). The most common intraoperative complication in the microkeratome group was major epithelial defect/sloughing; the rate (2.6%) was statistically significantly higher than in the femtosecond laser group (P = .0006). The most common postoperative complication in both groups was diffuse lamellar keratitis (DLK) (6.0%, microkeratome; 10.6%, femtosecond laser) (P = .0002). Although the total complication rates between the 2 groups were similar, the microkeratome group had significantly more epithelial defects intraoperatively and the femtosecond laser group had significantly more DLK cases postoperatively. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                Clinical Ophthalmology
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove Medical Press
                1177-5467
                1177-5483
                2013
                2013
                08 July 2013
                : 7
                : 1365-1371
                Affiliations
                [1 ]Shinagawa LASIK Center, Chiyoda-ku, Tokyo, Japan
                [2 ]Department of Ophthalmology, Wenzhou Medical College, Wenzhou, People’s Republic of China
                [3 ]Eye Can Cataract Surgery Center, Manila, Philippines
                Author notes
                Correspondence: Minoru Tomita Shinagawa LASIK Center, Yurakucho ITOCiA 14F, 2-7-1 Yurakucho, Chiyoda-ku, Tokyo, 100-0006, Japan, Tel +81 3 5221 8137, Fax +81 3 5221 3138, Email tomita@ 123456shinagawa-lasik.com
                Article
                opth-7-1365
                10.2147/OPTH.S47341
                3711877
                23874077
                4a6fc062-c6c1-42dd-ba38-12404b527116
                © 2013 Tomita et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Original Research

                Ophthalmology & Optometry
                lasik,ziemer,femto ldv,dlk,intralase fs60,femtosecond laser
                Ophthalmology & Optometry
                lasik, ziemer, femto ldv, dlk, intralase fs60, femtosecond laser

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