Thin flap laser in situ keratomileusis: flap dimensions with the Moria LSK-One manual microkeratome using the 100-microm head.

PURPOSE: To determine the predictability and consistency of corneal flap thickness, flap diameter, and hinge length with the modern 100 microm head of the Moria LSK-One manual microkeratome. SETTING: Private clinic, office-based practice. METHODS: Forty-two consecutive eyes with no previous surgery having thin flap laser in situ keratomileusis with the Moria LSK-One manual microkeratome had a new 100 microm (predicted flap thickness) head used for flap creation. Flap thickness was measured intraoperatively by subtraction ultrasound pachymetry (difference between central corneal thickness before flap cutting and residual stromal bed thickness after flap lifting). Vertical flap diameter and nasal hinge length were measured with calipers. RESULTS: Mean flap thickness was 107 microm +/- 14 (SD) (range 82 to 137 microm). Standard deviation for mean vertical flap diameter was +/-0.24 mm. The cord length of the nasal hinge was variable with a mean of 4.26 +/- 0.63 mm (range 3.12 to 5.75 mm) in length. Postoperatively, there were no slipped flaps, flap striae, diffuse lamellar keratitis, or epithelial defects; there was 1 epithelial slide. At 1 day, the visual acuity was 20/20 or better in 76% of eyes. CONCLUSIONS: The 100 microm head of the Moria LSK-One manual microkeratome cut a very predictable flap thickness and diameter but with variable length hinges. This flap thickness predictability was superior to that in other series with thicker intended flaps cut with mechanical microkeratomes and is comparable to that reported with the IntraLase FS femtosecond laser. Visual recovery was rapid, epithelial risks minimal, efficiency superior, and cost nominal relative to femtosecond laser technology.

US trends in refractive surgery: 2003 ISRS/AAO survey.

PURPOSE: To determine the latest trends in refractive surgery in the United States. METHODS: All U.S. members of the International Society of Refractive Surgery of the American Academy of Ophthalmology were mailed the 2003 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of new emerging technology. Questions regarding radial keratotomy (RK), astigmatic keratotomy (AK), limbal relaxing incisions (LRI), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis (LASEK), intracorneal ring segments (ICRS), laser thermokeratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), clear lens extractions (CLE), and scleral expansion (SE) procedures were examined in the survey. Use of lasers, microkeratomes, pupillometry instruments, postoperative medications, wavefront analyzers, topographers, etc were examined. RESULTS: In 2003, LASIK continued to dominate for refractive errors between -8.00 to +3 diopters. Surgeons are waiting on the PIOL for high myopes and are performing CLE for high hyperopes. Photorefractive keratectomy, LASIK, LASEK, CLE, PIOL, and CK appeared to have bright futures; whereas, RK, ICR, LTK and SE were on the decline. Bilateral LASIK at the same surgical session is offered by 98% of surgeons. VISX lasers are used 2:1 over all other lasers in the United States. Zeiss-Humphrey still dominates topographers at 37%. The Bausch & Lomb Hansatome (48%) leads microkeratomes. Surgeons are charging, on average, 300-500 dollars more per eye for custom ablations and these ablations have already been accepted and integrated into refractive practices. Comanaging of refractive surgery patients is significantly down from previous years. Fourth-generation fluoroquinolones overtook the postoperative antibiotic prescriptions, with prednisolone and fluoromethalone dominating as anti-inflammatories. CONCLUSIONS: Trends and changes as refractive surgery grows in the mainstream of ophthalmology in the United States continue to be elucidated by this professional organization survey.

Trends in refractive surgery in the United States.

To determine the latest trends in refractive surgery in the United States, a survey dealing with volumes, types, preferences, and use of emerging technology was sent to 5000 U.S. members of the American Society of Cataract and Refractive Surgery. Refractive surgery techniques and the use of lasers, microkeratomes, pupillometry instruments, postoperative medications, wavefront analyzers, and topographers were examined.

US trends in refractive surgery: 2002 ISRS survey.

PURPOSE: To determine the latest trends in refractive surgery in the United States. METHODS: The full U.S. membership of the International Society of Refractive Surgery (ISRS) (approximately 900 members) was mailed the 2002 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of emerging technology. RESULTS: Questions regarding RK, AK, PRK, LASIK, LASEK, intracorneal ring segments (ICRS), laser thermal keratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), and clear lens extractions (CLE) were examined in the survey. Procedure preference for low, moderate, and high myopia, and hyperopia, were compared with the results from the surveys of the previous 5 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of co-management of refractive surgery patients were compared with 1999-2001 data. New questions regarding pupil measurement/documentation, wavefront aberrometry, and custom ablations were incorporated into the 2002 survey. CONCLUSIONS: As refractive surgery grows in the mainstream of ophthalmology, trends and changes in the United States continue to be elucidated by this professional organization survey. LASIK continues to dominate for refractive errors between -10.00 to +3.00 D. LASIK, LASEK, CLE, PIOL, and CK appear to have bright futures, whereas, RK, ICR, and LTK are on the decline. VISX continues to be utilized 2:1 over all other lasers combined, and instrumentation pupillometry is preferred 2:1 over pupil gauge cards. Currently, wavefront aberrometry and custom ablations are minimally employed but appear poised to be the wave of the future.

U.S. trends in refractive surgery: 2001 International Society of Refractive Surgery Survey.

PURPOSE: To determine the trends in refractive surgery in the United States in 2001. METHODS: The 980 U.S. members of the International Society of Refractive Surgery were mailed the 2001 refractive surgery survey dealing with volumes, types, and preferences of refractive surgery performed. Questions regarding radial keratotomy, astigmatic keratotomy, photorefractive keratectomy, laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis, intracorneal rings (Intacs), laser thermal keratoplasty, conductive keratoplasty, clear lens extraction, phakic intraocular lenses, and scleral expansion procedures for presbyopia were examined in the survey. Procedure preferences for low, moderate, and high myopia and hyperopia were compared with the results from the surveys of the previous 4 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of comanagement of refractive surgery patients were compared with 2000 data. RESULTS AND CONCLUSION: LASIK remains the dominant refractive surgery for refractive errors from -12.00 to +3.00 D; the VISX excimer laser and the Hansatome microkeratome are the most frequently used instruments for LASIK.