ABSTRACT
BACKGROUND: Microkeratomes are currently used for keratomiluesis in situ (automated lamellar keratoplasty) for myopia and hyperopia and for laser in situ keratomileusis (LASIK). Visual and refractive complications have been reported with these refractive surgical procedures. We compared two microkeratomes in their ability to resect corneal lamellae to gain insight into possible mechanism(s) of refractive and visual complications following lamellar refractive procedures. METHODS: Using an eyebank eye model, we performed automated lamellar keratoplasty to theoretically correct 10.00 diopters (D) of myopia using the Automated Corneal Shaper, manufactured by Chiron, Inc. and the MicroPrecision microkeratome, manufactured by Eye Technology, Inc. Diameters before (wet) and after fixation, thicknesses of excised tissue, and scanning electron microscopy were measured in a masked evaluation to compare instruments. Ultrasonic corneal pachymetry and a mechanical tissue compression gauge were also used to assess thickness of excised tissue. RESULTS: The Chiron automated corneal shaper created blade chatter marks at the edges of all excisions, smaller than anticipated excision diameters, and a wide range of tissue thicknesses. In contrast, the MicroPrecision microkeratome created smoother resections of all tissues without creating blade marks; tissue diameters and thicknesses were closer to the intended dimensions compared to the Chiron automated corneal shaper. CONCLUSION: Different microkeratomes create different morphologic features as they excise corneal tissue. Differences in instrument design, mechanics of the tissue excision and blade oscillation, and instrument traverse combined with surgical skill influence the configuration of lamellar keratotomies.
