Purpose: To compare laser in situ keratomileusis (LASIK) results obtained with the femtosecond laser (IntraLase Corp.) to those obtained using 2 popular mechanical microkeratomes. Setting: Private practice, Greensboro, North Carolina, USA. Methods: This retrospective analysis compared LASIK outcomes with the femtosecond laser to those with the Carriazo-Barraquer (CB) microkeratome (Moria, Inc.) and the Hansatome ® microkeratome (Bausch & Lomb, Inc.). The 3 groups were matched for enrollment criteria and were operated on under similar conditions by the same surgeon. Results: There were 106 eyes in the IntraLase group, 126 eyes in the CB group, and 143 eyes in the Hansatome group. One day postoperatively, the uncorrected visual acuity (UCVA) results in the 3 groups were similar; at 3 months, the UCVA and the best spectacle-corrected visual acuity results were not significantly different. A manifest spheroequivalent of ±0.50 diopter (D) was achieved in 91% of eyes in the IntraLase group, 73% of eyes in the CB group, and 74% of eyes in the Hansatome group ( P P P P = .001). Surgically induced astigmatism in sphere corrections was significantly less with the IntraLase than with the other devices ( P Conclusions: The IntraLase demonstrated more predictable flap thickness, better astigmatic neutrality, and decreased epithelial injury than 2 popular mechanical microkeratomes.

Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis

Laser in situ keratomileusis for myopia and astigmatism: Safety and efficacy: A report by the American Academy of Ophthalmology

Objectives To evaluate the natural course of age-related maculopathy (ARM) and to assess the incidence and absolute risk of its final stage, age-related macular degeneration (AMD). Methods In a population-based prospective cohort study of 6418 persons 55 years and older, we studied the incidence and natural course of ARM. Subjects underwent identical examinations, including stereoscopic fundus photography, at baseline and at 2.0 and 6(1/2) years' follow-up. Age-related maculopathy was graded according to the International Classification and Grading System for ARM and AMD, and stratified into 5 exclusive stages. Incidence was expressed in rates and 5-year absolute risks. Results At follow-up, 47 new cases of AMD were identified, with a ratio of neovascular-atrophic AMD of 1.4:1. The 5-year risk of AMD increased with more severe stages to 28.0% for subjects 55 years and older with indistinct drusen and pigmentary irregularities (stage 3). Age, but not sex, independently increased this risk to a maximum of 42.0% for subjects with stage 3 ARM who were 80 years and older. Individual ARM fundus signs that predicted best the development of AMD were 10 or more large drusen (> or =125 microm) and 10% or more of the grid area covered by drusen. Subjects who developed atrophic AMD showed no significant (P =.25) differences in baseline fundus signs and natural course compared with subjects who developed neovascular AMD. Conclusions We provided the absolute risk of AMD as a function of age and early ARM fundus signs, and showed that both are prominent independent risk factors. The progression of ARM stages follows, after the appearance of the first soft drusen, a distinct course at a gradual pace that accelerates with increasing age.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/415237/eeb20018.pdf

The risk and natural course of age-related maculopathy: follow-up at 6 1/2 years in the Rotterdam study.

LASIK complications: etiology, management, and prevention.

PURPOSE: To review the etiology, prevention, and management of laser in situ keratomileusis (LASIK) complications. METHODS: Review of literature and the experience of the authors. RESULTS: Careful preoperative screening is critical to prevention of many potential complications of LASIK. Flap complications that occur during surgery are typically managed by replacement of the flap and repeating the surgery or applying special methods such as transepithelial photorefractive keratectomy weeks to months following the initial procedure. A common source of serious complications is the use of a microkeratome that functions after improper assembly. Timely treatment of postoperative complications such as diffuse lamellar keratitis, flap striae, and infection is critical to an optimal outcome. CONCLUSION: Most complications of LASIK can be treated effectively and have minimal effect on the final outcome after surgery, if appropriate methods are used for management. [J Refract Surg 2001;17:350-379]

Mathew Y Wang

Papers

Epithelial ingrowth after laser in situ keratomileusis

Bilateral blindness and lumbosacral myelopathy associated with high-dose carmustine and cisplatin therapy.