SBK OUP Microkeratome (Moria,France)

A microkeratome is a precise, hand-held surgical instrument with an oscillating metal blade. It is used to separate the surface layers of the cornea and create a corneal flap during the first step of laser vision correction surgery. First, the microkeratome is placed over the eye, then suction is applied so that the microkeratome is held perfectly still during the procedure. The microkeratome creates a hinged flap, which is laid back while the excimer laser sculpts the cornea into the optimal shape. Once the cornea is re-sculpted into a shape that improves your vision, the tissue is repositioned and healing begins. Visit the LASIK procedure page for a complete step-by-step explanation of LASIK vision correction.

Femtosecond lasers are no match for Moria’s latest LASIK microkeratome, the sterile, disposable OUP SBK. Without the heat of an Intralase or Zeimer, this mechanical microkeratome creates a nearly perfect ultra-thin LASIK flap without heat, plasma formation, excessive inflammation, or residual tissue adhesions. Semi-planar, smooth flaps without the hassle.

Purpose :
To determine the average central flap thickness created by the Moria OUP SBK microkeratome.
Method:
Independent masked physician operators captured multiple Visante™ images (Zeiss: Anterior Segment Ocular Coherence Tomography) at several intervals after surgery to accurately measure the central flap thickness of a large sample of consecutive patients.

Results:
The Moria OUP SBK reliably fashioned flaps of 99 microns OD and 97 OS with less than 10 µicrons of standard deviation.
Conclusion:
Femtosecond lasers have been promoted as the only device capable of achieving SBK (Sub-Bowman’s Keratomileusis). This assertion has been shown to be false. Moria’s OUP SBK microkeratome has created true SBK flaps in a reliable and consistent manner. Free caps, stria, buttonholes, and epithelial injury have not occurred. Furthermore, the complications and costs associated with femtosecond flap creation are avoided. Central corneal flap thickness measured at least one week after surgery using a Zeiss Anterior Segment OCT (Visante™) and confirmed by two independent masked eye physicians demonstrated a mean of 99.22 microns [standard deviation = 8.87] in the right eye. Using the same blade for the second eye a slightly thinner mean left flap thickness of 97.15 micron [standard deviation = 10.39] was found. When patients with longer followup were segregated a different range of values was found. Presumeably, by this time the cornea was completely deturgessed and more closely represented the true and final central flap thickness. The right eyes averaged 97.35 microns [standard deviation = 7.8] and the left eyes averaged 97.07 microns [standard deviation = 11.08]. True to the nature of a mechanical microkeratome, the Moria OUP SBK microkeratome exhibits a semi-planar flap profile. Flap thickness measurements at 3 mm temporal to the corneal apex and 3 mm nasal to the apex along the horizontal meridian demonstrated a 15% increase in flap thickness regardless of the location of the hinge. This contour is most accurately described as semi-planar. The non-planar profile may actually enhance flap stability while minimzing the all important central corneal flap thickness. Over 500 Visante images were measured and re-measured to insure accuracy. The Visante™ flap tool determined the corneal surfaces. The placement of the flap indicator was manually adjusted only if the pattern recognition software failed. In this example the peripheral flap thickness was 107 µicrons when measured 3 mm nasal to the corneal apex. The flap thickness was 106 µicrons when measured 3 mm temporal to the corneal apex. The central corneal flap thickness was 96 µicrons.

Advantages

There are several advantages of using the microkeratome in laser vision correction. Compared with other options, such as “bladeless” LASIK, the microkeratome method is generally faster and more comfortable for the patient. The microkeratome procedure typically lasts about three seconds, compared with 15-20 seconds with IntraLase®. In addition, less suction is necessary with the microkeratome procedure, and less inflammation occurs afterward.

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