Laser in situ keratomileusis enhancements with the Ziemer FEMTO LDV femtosecond laser following previous LASIK treatments

• Published in: Graefe's archive for clinical and experimental ophthalmology 2013-02, Vol.251 (2), p.597-602
• Main Authors: Pietilä, Juhani, Huhtala, Anne, Mäkinen, Petri, Uusitalo, Hannu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Corneal Stroma - surgery; Female; Humans; Hyperopia - physiopathology; Hyperopia - surgery; Intraoperative Complications; Keratomileusis, Laser In Situ - methods; Lasers, Excimer - therapeutic use; Male; Medicine; Medicine & Public Health; Middle Aged; Myopia - physiopathology; Myopia - surgery; Ophthalmology; Postoperative Complications; Refractive Surgery; Reoperation; Reproducibility of Results; Surgical Flaps; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-012-2110-9

Background The aim of this paper is to present the accuracy, predictability, and safety outcomes of LASIK enhancements performed with the FEMTO LDV femtosecond laser (Ziemer Ophthalmic Systems, Port, Switzerland) and the Allegretto Wave Concerto 500 Hz excimer laser (Wavelight AG, Erlangen, Germany), following previous LASIK treatments. Methods FEMTO LDV was used for flap creation in 85 previously LASIK-treated eyes of 62 patients. The intended flap thickness was 90 μm in 81 eyes and 140 μm in 4 eyes. The size of the suction ring was 9.0 mm in 72 eyes and 9.5 mm in 13 eyes. Flap dimensions were measured and correlated to preoperative characteristics. Results With the intended flap thickness of 90 μm in previously LASIK-treated eyes, the actual flap thickness was 90.2 ± 6.6 μm (range 80–122), and the flap diameter was 9.2 ± 0.2 mm (range 8.7–9.9). The mean hinge length was 4.0 ± 0.2 mm (range 3.0–4.8). Flap thickness correlated positively with patient age and hinge length. Complications were reported in 12 eyes (14.1 %). Most of the complications were very mild, and none of them prevented further refractive laser treatment. One eye lost two Snellen lines of best spectacle-corrected visual acuity. Conclusions Femtosecond LASIK enhancement is warranted only in rare cases. Surgical experience is needed and special caution must be practiced. For cases of a primary free cap, femtosecond LASIK is not recommended.