Flap creation put to test of new femtosecond laser

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A study assessing the performance of a new femtosecond laser platform (Victus, Bausch + Lomb) showed it created LASIK flaps that deviated minimally from targets for thickness and diameter.

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See how the femtosecond laser creates LASIK flaps that are uniform with no central opaque bubble layers and smooth stromal beds. (Video courtesy of Bausch + Lomb)

San Francisco-A new femtosecond laser system (Victus, Bausch + Lomb) is a reliable tool for creating high-quality LASIK flaps of intended dimensions.

And, it performs similarly to time-tested technology, said Dr. Whitman, private practice, Dallas. However, the new femtosecond laser platform is one of only two systems in the United States that can also be used in cataract surgery.

“When new technology becomes available, it is important to understand how it compares with existing modalities,” said Dr. Whitman, at the annual meeting of the American Society of Cataract and Refractive Surgery.

“For LASIK flap creation, we have found that [this] . . . femtosecond laser performs at least as well as the current gold standard, but it brings an added advantage of greater versatility,” he said. “The ability to use a single platform for corneal and cataract surgery applications is an attractive feature for a practice considering the purchase of femtosecond laser technology.”

Dr. Whitman

Series of 10 eyes

Dr. Whitman assessed the performance of the new femtosecond laser as a flap-cutting tool in a series of 10 eyes undergoing LASIK for myopic or hyperopic correction. Ease of flap lifting and stromal bed quality was assessed intraoperatively, and the eyes underwent anterior segment optical coherence tomography imaging at 1 month postoperatively for measurements of flap thickness and diameter. Four flap thickness measurements were made in each eye and the data were used to calculate the average flap thickness per eye.

The intraoperative observations revealed that flap lifts were uniform with no central opaque bubble layer issues and stromal beds were smooth and regular.

The flap measurements showed excellent predictability. Targeted flap thickness for the 10 eyes ranged from 110 to 150 μm. For the individual eyes, deviation between the intended target and achieved average flap thickness ranged from –0.6 to 2.8 μm with an average of 0.48 μm. Standard deviation for the four flap thickness measurements in each eye was ≤3.6 μm.

Intended flap diameters were 8.7 or 8.8 mm, and the achieved diameter matched the target in 6 eyes and deviated by only 0.1 mm in the other 4 eyes.

The flap bed was created by the femtosecond laser platform. The study found that LASIK flaps performed by the laser deviated minimally from targets for thickness and diameter. (Photo courtesy of Bausch + Lomb)Comparing flap thickness outcomes

Dr. Whitman also compared the flap thickness outcomes using this particular femtosecond laser with those he achieved in a group of 10 eyes undergoing flap creation using a 60-kHz femtosecond laser (IntraLase, Abbott Medical Optics). The comparator group eyes were matched by intended flap thickness, and across the 10 eyes, the deviation between the intended and achieved average flap thickness ranged from –3.6 to 1.2 μm with an average of –0.88 μm. The standard deviation for the four flap thickness measurements in each eye was ≤5.2 μm.

Intended diameters for the IntraLase-created flaps ranged from 8.5 to 9 mm. The achieved diameter matched the target in 4 eyes and varied by just 0.1 μm in the other 6 eyes.

“Both of these femtosecond lasers provide excellent results in creating flaps with the targeted diameter and thickness,” Dr. Whitman said. “The outcomes with the new Victus are as good as if not better than those achieved with the IntraLase.”

Jeffrey Whitman, MD

E: docw56@sbcglobal.net

Dr. Whitman is a consultant to Bausch + Lomb.

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