A retrospective analysis and comparison of 1024 eyes having undergone wavefront-guided thin flap femtosecond LASIK versus wavefront-guided thin flap microkeratome LASIK

Session Details

Session Title: LASIK Outcomes II

Session Date/Time: Tuesday 16/09/2014 | 14:00-16:00

Paper Time: 14:12

Venue: Capital Hall B

First Author: : D.Mathur INDIA

Co Author(s): :    R. Dutta   N. Shroff           

Abstract Details

Purpose:

To compare the visual function, safety, efficacy, flap complication rate, residual cylinder, higher order aberrations and overall patient satisfaction after Wavefront-guided thin flap Femtosecond LASIK and Wavefront-guided thin flap Microkeratome LASIK in 1024 eyes with Myopia.

Setting:

Cornea & Refractive Service, Shroff Eye Centre, A-9, Kailash Colony, New Delhi - 110048, India.

Methods:

422 eyes of 224 patients with myopia of -2.75 to -7.25 D (Mean -4.64 ± 1.32) and astigmatism of -0.50 to -3.75 D (Mean -1.77 ± 0.87) underwent Advanced CustomVue Treatment with the IntraLase FS 150 Hz femtosecond laser (90 micron flap). 602 eyes of 232 patients with myopia of -2.75 to -6.75 D (Mean -4.61 ± 1.34) and astigmatism of -0.25 to -3.00 D (Mean -1.61 ± 0.63) underwent Advanced CustomVue Treatment with the Amadeus II Microkeratome (120 micron flap). The patients were followed for 12 months after surgery. The primary outcome measures compared were uncorrected visual acuity, residual cylinder, predictability, intra-operative and post-operative flap complications, amount of higher order aberrations, contrast sensitivity and overall patient satisfaction.

Results:

94.1% of the IntraLase group versus 79.2% of the Microkeratome group achieved 20/20 or better unaided vision at 1 month (p < .001). In the Intralase group, mean residual cylinder was 0.27 ± 0.43 D, while in the Microkeratome group it was 1.01 ± 0.78 D (p < .001). The mean logMAR unaided visual acuity on 1 month, 6 months and 12 months was 0.02 ± 0.11, 0.01 ± 0.12 and -0.01 ± 0.06 in the IntraLase group, and 0.1 ± 0.26, 0.04 ± 0.31 and 0.03 ± 0.31 in the Microkeratome group (p < .01). Overall flap complication rate was 8.4% in the Femtosecond laser group, and 12.2% in the microkeraatome group. Intra-operative flap complication rate in the femtosecond group was 0.4% versus 4.3% in the microkeratome group (p < .001). Diffuse Lamellar Keratitis and dislocated flaps were the most common post-operative complication in the femtosecond and the microkeratome groups respectively. All eyes showed a reduction in pre-existing HOA RMS error with an overall mean reduction of 74.2% in the IntraLase group compared to 57.1% in the Microkeratome group (p < .001). At 12 months, patient satisfaction questionnaires showed higher satisfaction in the femtosecond group.

Conclusions:

Both treatments were safe, effective and predictable. In both groups complication rates were comparable. However, the femtosecond group showed a marked and rapid improvement in post-operative unaided visual acuity with less post-operative cylinder than the Microkeratome group. This group had less residual higher order aberrations, overall increased patient satisfaction, and marginally better results in all parameters.

Financial Interest:

NONE