Femtosecond laser or microkeratome?

Laser vision correction is a combination of laser surgery and mechanical impact on an eye tissue: the parameters of the laser – its quality and preciseness – determine the outcome and the effectiveness of the treatment and a microkeratome is responsible for preparing the area of a laser operation, the length of the treatment and a healing process. The microkeratome is highly professional equipment made up from a steering console, wires and different heads suitable to various methods of treatment. Thanks to it we can separate an epithelial flap with very smooth surface and edges. Femtosecond laser was supposed to be alternative to the microkeratome: it is used to form an epithelial flap by creating an area, where CO2 and H2O bubbles appear thanks to laser impulses. As a result, collagen fibres are torn apart in a process called photodisruption. Such violent processes do not allow to separate an epithelial flap with very smooth surface and edges.

Only 20 percent of laser vision correction treatments in Europe are performed using the femtosecond laser and 80 percent with the use of microkeratome.

“Applying both methods has brought very good results in case of people suffering from short-sightedness. The LASIK method with the use of microkeratome brought not only better results in achievingthe quality of corneal stroma tissue and an epithelial flap, but also it was easier to use and more patient-friendly during the treatment.” – said doctor Maja Bohac (Svjetlost Ophthalmological Clinic, Zagreb, Croatia) during the 28th ESCRS congress.

“Looking at layers of corneal stroma performed with mechanical microkeratome in high magnification, you can notice that the surface is smooth without any irregularities caused by joining the tissues. However, looking at corneal stroma tissue after using femtosecond laser, despite high quality and smoothness of the epithelial flap, you could notice some irregularities caused by joining the tissues” – doctor Bohac added.

Refractive surgeons also point to lifting and manipulating epithelial flaps being definitely easier with the use of microkeratome. Moreover, doctor Bohac pointed to the fact of greater discomfort amongst patients that underwent the procedure with the use of femtosecond laser: “The discomfort felt during the LASIK treatment with the use of femtosecond laser is caused by a large piece of equipment being put on the nose, almost half of the cheek and over the patient's eye. Since setting the equipment and creating the epithelial flap takes about a minute, a patient feels a slight or sometimes stronger pressure against his eye and the surrounding area. Some patients say about a claustrophobic feeling they had during the procedure” – she said. It is worth comparing it to the microkeratome treatment, which takes only 20 seconds.

Moreover, there is also the issue of “the feeling of darkness”: it is a temporary condition, when a patient cannot see anything (it refers to the amount of time, which is needed to create the epithelial flap after applying vacuum on the eye to reach the right amount of suction) – in case of the microkeratome it is much shorter in comparison with the femtosecond laser. It is also important to notice that preparing the femtosecond laser and the operating room as well as the treatment itself takes twice as long as the procedure with the use of the microkeratome.

The financial factor, apart from safety and comfort, is also on the side of microkeratome: patients that decide for the LASIK treatment with the use of femtosecond laser have to deal with a much higher cost in comparison with the same treatment using the microkeratome.

Source: www.eyelaser.pl

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