Article

IntraLASIK yields benefits for conventional and wavefront-guided procedures

San Francisco—Whether using a conventional ablation technique or CustomCornea (Alcon Laboratories) wavefront-guided procedures, all-laser LASIK (IntraLASIK) performed with femtosecond microkeratome (IntraLase) flap creation affords better efficacy and safety outcomes compared with surgery performed with mechanical microkeratome-created flaps, according to the results of a retrospective study conducted by Ella G. Faktorovich, MD.

Dr. Faktorovich, director, cornea and refractive surgery, Pacific Vision Institute, San Francisco, analyzed outcomes for age- and refraction-matched cohorts of patients undergoing LASIK at her institution. The wavefront group included 226 eyes, and there were 265 eyes in the conventional LASIK group. The Hansatome (Bausch & Lomb) microkeratome was the mechanical microkeratome used, and all ablations were performed with the LADARVision 4000 laser (Alcon).

Outcomes were assessed at 1, 3, and 6 months postoperatively and showed better uncorrected visual acuity (UCVA) accompanied by less loss of best-corrected visual acuity (BCVA) for the femtosecond laser groups compared with those undergoing mechanical microkeratome flap creation, especially at 3 months. At 6 months, there was less induced cylinder in the femtosecond laser group among the eyes undergoing conventional LASIK.

"While it would be desirable to have a prospective study with a larger sample size and compare the two treatments in fellow eyes, our results do favor the all-laser procedure, and there are a number of possible reasons that could account for some of the differences observed," said Dr. Faktorovich.

"When using the femtosecond laser, however, we do think it is important to use a technique that will minimize opaque bubble layer formation, and we are continuing to monitor our settings to keep it and any problems with transient light sensitivity at a minimum," said Dr. Faktorovich.

Flap creation with the Hansatome microkeratome was performed using the 160-μm plate and 9.5-mm ring. The femtosecond laser procedure was performed using the following parameters: 250-μm pocket; spot separation 12/10, raster energy 1.6 to 2.0 mJ, side cut energy 1.6 to 1.9 mJ, 45° side cut, and 45° hinge. Intended flap thickness was 120 μm and flap diameter was 9.5 mm.

"Our technique aims to create a narrow hinge because we treat many Asian patients with smaller-diameter corneas in which a narrow hinge will allow for fuller bed exposure," explained Dr. Faktorovich.

The patients in the four study groups ranged in age from 22 to 63 years, and they had a mean age of about 37 years. Mean SE in the four groups ranged from –3.78 to –4.36 D.

The eyes in the wavefront group all had <1 D of cylinder since the treatments were performed prior to approval of the expanded range for CustomCornea treatment, whereas cylinder ranged up to 3.5 D in the conventional LASIK groups.

Newsletter

Don’t miss out—get Ophthalmology Times updates on the latest clinical advancements and expert interviews, straight to your inbox.

Related Videos
Abby Markward, MBA, and Hattie Hayes, editor of Ophthalmology Times Europe, discuss the ASCRS and ASOA meetings
Abby Markward discusses the ASCRS Foundation and the ASCRS Annual Meeting
(Image credit: Ophthalmology Times) Inside ASCRS 2025: Francis S. Mah, MD, takes the helm with a vision for research, education, and advocacy
(Image credit: Ophthalmology Times) NeuroOp Guru: Cranial nerve six palsy with chemosis is a critical clue to cavernous carotid fistula
(Image credit: Ophthalmology Times) Neda Shamie_Controversies in Modern Eye Care 2025
© 2025 MJH Life Sciences

All rights reserved.