Moria—M2显微角膜板层刀在LASIK术中应用的并发症及预防

目的探讨Moria．M2显微角膜板层刀在准分子激光原位角膜磨镶术（LASIK）中应用的并发症及预防。方法2126例（4226只眼）LASIK术中采用法国Moria—M2显微角膜板层刀制作角膜瓣。结果LASIK术中并发症有角膜瓣形成不全、角膜瓣完全游离、角膜瓣偏位、角膜瓣下基质床出现“岛屿现象”、发生走空刀、角膜瓣周边渗血、球结膜下出血、小角膜瓣。结论法国Moria—M2显微角膜板层刀安装方便,安全性、稳定性好,值得临床推广应用。     

两种不同制瓣方式对LASIK术角膜瓣厚度的影响

目的:比较Ziemer LDV飞秒激光与Moria M2机械板层刀不同制瓣方式对LASIK术角膜瓣厚度的影响。 方法：选取近视患者100例200眼（近视度数-2.00~-12.00D,散光度数0.00 ~ -3.50D）,分别应用Ziemer LDV飞秒激光（设定角膜瓣切削厚度110μm）与Moria M2 （110刀头）微型角膜刀制作角膜瓣,各50例 100眼。术后1wk,应用眼前节RTVue FD-OCT 测量,每个角膜上 0°,45°,90°,135°四条子午线所在截面上中心点、距离中心1,2,3mm特定7个点（共计28个点）的角膜瓣厚度测量,并作分析比较。 结果:角膜瓣中央点厚度:Ziemer LDV飞秒激光组108.69±11.75μm,Moria M2 微型角膜刀组130.75±13.36μm,所有观测点（共28点）两组间有明显统计学差异（P<0.01）。角膜中心点厚度与预计值差值比较:Ziemer LDV飞秒激光组 9.70±6.84μm,Moria M2 微型角膜刀组 21.63±11.79μm。Ziemer LDV飞秒激光组预计值差值明显低于Moria M2 微型角膜刀组（t=17.493,P＜0.01）。Ziemer LDV飞秒激光组与Moria M2微型角膜刀组同一截面中各点角膜瓣厚度值差异有统计学差异（P<0.01）。 结论:角膜瓣制作方式相比,在角膜瓣的精确性、可预测性等方面 Ziemer LDV飞秒激光优于Moria M2 微型角膜刀。Ziemer LDV组与Moria M2 机械板层刀组都未表现角膜瓣厚度的均匀性。     

Ziemer飞秒激光与Moria M2 90刀头制作角膜瓣的厚度与特点比较

目的  应用前节OCT测量比较Ziemer飞秒激光和Moria M2微型角膜刀90刀头制作的LASIK角膜瓣的特点。设计 前瞻性比较性病例系列。研究对象 88例近视患者176眼行LASIK,随机分为Ziemer飞秒激光和Moria M2微型角膜刀90刀头制作角膜瓣各44例88眼。方法  术后1周应用RTVue OCT测量两组患者角膜上0°、45°、90°和135° 4条子午线所在截面上特定7个点的角膜瓣厚度,并对角膜瓣上28个测量点的角膜瓣厚度值进行统计分析。主要指标 角膜瓣厚度和角膜瓣形态。结果 术后1周,飞秒激光组中央角膜瓣厚度为（106.03±6.64） ?滋m,平均角膜厚度（107.38±5.46） ?滋m,均明显低于Moria M2 90组的中央角膜瓣厚度（134.41±11.31） ?滋m和平均角膜瓣厚度（139.38±8.91） ?滋m（P均<0.01）, 飞秒激光组与角膜瓣预期厚度值110 ?滋m更接近,差值为（7.15±4.89） ?滋m,而机械板层刀组角膜瓣厚度值与预计厚度110 ?滋m的差值为（29.51±14.31） ?滋m （P<0.01）。结论 飞秒激光制作角膜瓣的厚度更薄,全角膜瓣厚度平均值更接近预期的110 ?滋m,其角膜瓣的均一性和预测性更好,是薄瓣LASIK手术的首选。（眼科,2013,22： 261-265）     

LASIK术中110μM角膜瓣的临床应用观察

目的探讨LASIK术中运用90μ厚刀头制作110μm角膜瓣的技巧和效果。方法采用Moria M2双马达自动旋转式显微角膜刀为937例(1834只眼)行准分子激光原位角膜磨镶术(LASIK)的患者制作角膜瓣。刀头选择90μ厚,终止环设定在7.5位置,吸力环根据角膜曲率表选择。结果所有患眼角膜瓣制作均顺利,除2例纽孔样角膜瓣外,无不良瓣,蒂大小适中,瓣翻转自如,复位容易。无卡刀及中途停顿现象,术后除2例角膜瓣皱褶需重新复位外其余对合复位良好。结论Moria M2 90μ厚显微角膜刀所制作薄角膜瓣在厚度上有良好可预测性,尽可能保留更多厚度基质床,明显提高了手术的安全性。     

两种微型角膜板层刀在准分子激光原位角膜磨镶术的效果比较

目的对MoriaM2130型(以下简称M2)一次性微型角膜刀头(自带刀片)与微型角膜刀片的角膜瓣制作效果进行比较。方法59例准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)手术患者(113眼),随机使用两种刀来制作角膜瓣,记录角膜瓣直径、蒂长,术后应用共焦显微镜测量瓣厚,记录术中和术后的并发症,对结果作统计分析比较。结果使用M2一次性刀头与M2刀片时,制作的角膜瓣平均厚度分别为(139.35±19.07)μm、(126.92±11.50)μm(t=4.096,P<0.01)。同一患者双眼使用同一把刀,两眼角膜瓣厚度无明显差异。术中角膜瓣的制作均一次成功,无严重并发症。结论M2型一次性刀头与刀片均具有安全性和稳定性。一次性刀头使用更方便,角膜瓣下干净,但角膜瓣厚度的平均值较高,标准误差较大。M2型刀片的角膜瓣制作效果相对稳定,但角膜瓣下残留相对多的金属颗粒。     

飞秒激光辅助个体化准分子激光原位角膜磨镶术疗效观察

目的 观察飞秒激光制作角膜瓣的波前像差引导的LASIK手术早期治疗效果,并与常规波前像差引导的LASIK手术比较.方法 在波前像差引导的个体化角膜切削前,分别使用飞秒激光机和Moria M2微型角膜板层刀为各30例(飞秒组和机械组各60只眼)近视患者制作同厚度角膜瓣,手术前后观察裸眼视力、眼波前像差、对比敏感度,并比较两组患者临床效果.结果 术后3个月两组裸眼视力均提高,有效性和安全性指数:飞秒组:1.19;1.20.机械组:1.16;1.15.术后两组等效球镜度数变化相似.两组术后3个月,飞秒组球差增加小于机械组.飞秒组最高空间频率(18c/deg)对比敏感度比术前提高.机械组相同频率对比敏感度术后1月下降,术后3个月恢复至术前水平,结论 与使用Moria M2微型角膜板层刀制作角膜瓣的波前像差引导的个体化LASIK手术比较,使用飞秒激光制作角膜瓣的波前像差引导的个体化LASIK手术后早期,裸眼视力相似,球差增加较少,屈光状态更稳定,高空间频率的对比敏感度增加更多,显示出更好地治疗效果.     

与角膜瓣有关的LASIK并发症的预防及处理

目的 :探讨与角膜瓣有关的LASIK并发症预防及处理。方法 :采用Moria直推式和旋转式板层刀 (法国产 )对3810眼行LASIK ,并对其中与角膜瓣有关的并发症进行观察。结果 :与制作角膜瓣相关的LASIK并发症依次为游离瓣、瓣制作不全、瓣移位和瓣皱褶、薄瓣、瓣破裂、瓣自溶、瓣丢失 ,计 88眼 ,占总手术的 2 .2 3%。出现这些并发症的主要原因有 :真空泵的负压影响、板层刀的选择、患者本身的危险因素等等。这些并发症经过及时正确的处理 ,预后均良好。结论 :LASIK治疗近视安全有效 ,通过严格执行手术操作和使用良好设备有助于进一步减少并发症的发生     

Moria M290一次性微型板层角膜刀制作角膜瓣的临床研究

目的：探讨Moria M290一次性微型板层角膜刀制作角膜瓣的可预测性及其影响因素。方法共入选104例（208只眼）拟行准分子激光原位角膜磨镶术（LASIK）患者参加此研究。术中使用Moria M290一次性微型板层角膜刀制作角膜瓣,所有患者均使用全新刀头,先右眼制瓣,然后左眼制瓣。制瓣前及制瓣后均使用超声角膜测厚仪测量术眼中央角膜厚度,同时测量角膜瓣直径及蒂长。结果平均角膜瓣厚度为（113．26±12．12）μm,其中右眼平均角膜瓣厚度为（121．42±12．08）μm,左眼平均角膜瓣厚度为（107．24±12．24）μm,两者比较有显著统计学差异（P ＜0．01）。右眼平均角膜瓣直径（9．46±0．15）mm,平均蒂长（5．16±0．25）mm;左眼平均角膜瓣直径（9．39±0．19）mm,平均蒂长（5．09±0．24）mm,两者比较均无显著性差异（P ＝0．08和P ＝0．95）。角膜瓣厚度与患者年龄,术前屈光度,术前角膜曲率及角膜直径均无明显相关性（分别P ＝0．56,P ＝0．50,P ＝0．19,P ＝0.42）,与术前中央角膜厚度呈正相关性（r ＝0．448,P ＜0．01）。结论 Moria M290一次性微型板层角膜刀制作角膜瓣预测性良好,角膜瓣厚度与术前中央角膜厚度呈正相关性。     

Moria M2型90与110刀头在LASIK中应用的随机对照研究

目的：观察Moria M2型90与110μm角膜刀制作角膜瓣在准分子激光角膜原位磨镶术（laser in situ keratomileusis,LASIK）的疗效和并发症,探讨Moria M2型90刀头在LASIK中应用的有效性、安全性和优点。 方法：选取通过术前检查并自愿行LASIK手术的患者105例202眼,按随机数字表分成两组,使用Moria M2型90刀头LASIK患者51例98眼,110刀头LASIK患者54例104眼做对照,术后即使用光学相干断层扫描仪（OCT）检测两组角膜瓣厚度,观察两组术后1d;1wk;1,3mo裸眼视力、矫正视力和角膜瓣形态、对合情况、并发症。 结果：90刀头组术后角膜瓣厚度为118.3±15.2μm,110刀头组术后角膜瓣厚度为130.5±17.1μm,有显著性差异。90刀头组均未发现层间点状金属碎屑,110刀头组有层间点状金属碎屑个例（12例）,有显著性差异。两组角膜瓣形态、对合情况、术后反应、术后裸眼视力相当。 结论：应用90刀头LASIK的疗效及并发症和110刀头LASIK相当,但90刀头保留角膜基质床相对较厚,可矫治的屈光度更大,术后层间点状金属碎屑并发症更少,具有更好的安全性和更宽的适应范围。     

眼前节OCT测量法对FS200飞秒激光和Moria 90刀头行薄瓣LASIK中角膜瓣形态比较

背景 薄瓣准分子激光角膜原位磨镶术(LASIK)是角膜屈光手术的主流方法,越来越多的薄瓣LASIK应用飞秒激光制作角膜瓣,傅里叶眼前节OCT角膜瓣厚度及形态的测量为角膜瓣和角膜基质层厚度的控制提供了依据,但应用眼前节OCT测量法对FS200飞秒激光和Moria 90刀头行薄瓣LASIK中角膜瓣形态进行比较的研究较少. 目的 利用傅里叶频域OCT测量法比较应用Wavelight FS200飞秒激光和传统微型角膜刀Moria 90刀头制作的角膜瓣形态及其厚度,评价两种方法制作角膜瓣的特点. 方法 选取2011年12月至2012年6月在南京同仁医院眼科行FS200飞秒激光辅助LASIK和Moria 90刀头行LASIK的患者各30例30眼,于术后1个月应用傅里叶频域OCT(OPTOVUE RTVue-100)测量和比较两种方法所制的中央角膜瓣厚度以及角膜0°和90°径线所在截面上特定10个点的角膜瓣厚度. 结果 FS200飞秒激光制瓣组术眼中央角膜瓣厚度值为(112±3)μm,全角膜瓣平均厚度值为(112±3) μm,分别低于Moria 90刀头制瓣组的(121±7) μm及(128±11) μm,差异均有统计学意义(P=0.031、0.030),FS200飞秒激光制瓣组角膜瓣厚度的变异范围也明显小于Moria 90刀头制瓣组.FS200飞秒激光制作的角膜瓣形态规整、均一,形状近似规则的平面,其中央、旁中央、周边厚度的差异无统计学意义(P=0.320).Moria 90刀头制作的角膜瓣中间薄,周边厚,近似弯月形透镜,其中央、旁中央、周边区角膜瓣厚度的差异有统计学意义(P=0.038).FS200飞秒激光制瓣组各测量点角膜瓣厚度与预期角膜瓣厚度(110 μm)的平均差为(3±4)μm,而Moria 90刀头制瓣组为(17±10) μm,两组间差异有统计学意义(P=0.009).结论 傅里叶眼前节OCT测量表明,Wavelight FS200飞秒激光制作角膜瓣精确度高,可控性强,稳定性好,且操作更安全,是薄瓣LASIK的首选.傅里叶眼前节OCT是评价LASIK术后角膜瓣形态和厚度的有用工具.     

两种LASIK角膜刀在低中度近视术中的临床应用

目的:观察90刀头超薄角膜瓣和110刀头常规角膜瓣在低中度近视患者手术前后的诸多指标的对比研究,探讨超薄瓣LASIK手术的优缺点。方法:根据患者知情原则及患者自愿选择分为两组:组1(使用常规Moria110μm刀头组)81例159眼;组2(使用Moria90μm一次性刀头组)73例145眼。术中测量实际角膜瓣厚度,观察两组角膜瓣形态、对合情况、术后反应、并发症,检测两组角膜厚度、角膜瓣厚度、剩余角膜基质厚度及术后预测视力、眼压等指标。结果:组1实际角膜瓣厚度为134.0±2.5μm,组2为93.5±5.9μm,两组差异有统计学意义(P<0.05)。两组角膜瓣形态、对合情况、术后反应和术后预期视力及眼压差异无统计学意义(P>0.05)。90超薄瓣组并发症更少,保留的角膜基质床更厚(P<0.05)。结论:90超薄角膜瓣LASIK与110常规角膜瓣LASIK相比,能取得同样良好的矫治效果,而超薄角膜瓣LASIK可矫治的屈光度更大,保留的角膜基质床更多,具有更好的安全性、稳定性和更宽的适应范围,将成为不同程度近视患者的首选术式。     

Comparison of flap thickness reproducibility using microkeratomes with a second motor for advancement

PURPOSE: To compare flap thickness and reproducibility of four different types of microkeratomes during LASIK. DESIGN: Retrospective, nonrandomized, comparative case series. PARTICIPANTS: Four hundred ninety consecutive eyes underwent LASIK and were evaluated by measuring the central flap thickness by subtractive pachymetry. METHODS: All flaps were created using the Bausch & Lomb (Miami, FL) Hansatome 180 head, the Alcon (Fort Worth, TX) Summit Krumeich Barraquer Microkeratome 160 head, the Moria (Antony, France) Carriazo Barraquer (CB) 130 head, or the Moria M2 110 head. RESULTS: The flap thickness measurements differed according to the microkeratome used and were 131+/-28 microm in 41 eyes (8.4%) with the Bausch & Lomb Hansatome 180 head, 162+/-21 microm in 127 eyes (25.9%) with the Alcon Summit Krumeich Barraquer Microkeratome (SKBM) 160 head, 157+/-40 microm in 65 eyes (13.3%) with the Moria CB 130 head, and 134+/-23 microm in 257 eyes (52.4%) with the Moria M2 110 head. The central flap thickness with the SKBM and Moria M2 was statistically significantly more reproducible than with the Moria CB (P< 0.0005). There is no correlation between flap thickness reproducibility and age, corneal thickness, or corneal keratometric values. However, considering all the microkeratomes, female gender had statistically significantly more variability than male gender (P<0.02). CONCLUSIONS: Based on these results, the greatest predictability of flap thickness was seen with the SKBM and Moria M2 microkeratomes, which both use a second motor for advancement. The greatest variability, noted with the Moria CB, was likely due to the manual translation feature and places further importance on the safety of the second motor and automation when performing LASIK.     

准分子激光原位角膜磨镶术术前角膜厚度对术中角膜瓣厚度的影响

目的探讨准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK）术前角膜厚度对术中角膜瓣厚度的影响。方法回顾性分析行双眼LASIK手术的患者150例（300眼）,按手术前角膜厚度分为四组：Ⅰ组36例,术前角膜厚度为（483.00±35.60）μm;Ⅱ组39例,术前角膜厚度为（516.00±36.33）μm;Ⅲ组36例,术前角膜厚度为（546.00±36.23）μm;Ⅳ组39例,术前角膜厚度为（579.00±37.30）μm。应用法国MoriaM2显微角膜刀制作角膜瓣,预期制作角膜瓣厚度160μm,每位患者用同一角膜刀制作双眼角膜瓣,手术顺序为先右眼后左眼。由MICKOPACH200P＋（SonomedInc.）超声测厚仪测量术前角膜厚度及术中激光切削前角膜瓣下基质厚度,角膜瓣厚度为术前角膜厚度减去术中激光切削前角膜瓣下基质厚度。对角膜瓣厚度进行统计学分析（方差分析和相关分析）。结果①角膜瓣厚度波动范围为79186μm,平均为（138.05±21.37）μm,角膜瓣厚度与术前角膜厚度呈正相关（r=0.710,P〈0.01）。②角膜瓣厚度与法 国Mo-riaM2显微角膜刀制作角膜瓣标识值（160μm）差异有显著的统计学意义（t=116.60,P〈0.01）,角膜瓣厚度比标识值薄。结论①角膜厚度影响角膜瓣厚度变化,两者呈正相关,手术前角膜越厚,角膜瓣越厚。②本研究所测得的角膜瓣厚度比预期值薄,角膜瓣厚度在一定范围内变化。     

Effect of femtosecond and microkeratome flaps creation on the cornea biomechanics during laser in situ keratomileusis: one year follow-up

AIM: To compare the corneal biomechanical outcomes at one year after laser in situ keratomileusis (LASIK) with the flaps created by Ziemer and Moria M2 microkeratome with 110 head and -20 blade. METHODS: Totally 100 eyes of 50 consecutive patients were enrolled in this prospective study and divided into two groups for corneal flaps created by ZiemerFemto LDV and Moria M2 microkeratome with 110 head and -20 blade. Corneal biomechanical properties including cornea resistance factor (CRF) and cornea hysteresis (CH) were measured before and 1, 3, 6, 12mo after surgery by ocular response analyzer. Central cornea thickness and corneal flap thickness were measured by optical coherence tomography. RESULTS: The ablation depth (P=0.693), residual corneal thickness (P=0.453), and postoperative corneal curvature (P=0.264) were not significant different between Ziemer group and Moria 110-20 group after surgery. The residual stromal bed thickness, corneal flap thickness, CH and CRF at 12mo after surgery were significant different between Ziemer group and Moria 110-20 group (P<0.01);Ziemer group gained better corneal biomechanical results. The CRF and CH increased gradually from 1 to 12mo after surgery in Ziemer group, increased from 1 to 6mo but decreased from 6 to 12mo in Moria 110-20 group. Both CRF and CH at one year after surgery increased with the increasing of residual cornea thickness; pre-LASIK CRF, CRF also increased with residual stromal bed thickness, while CH decreased with the increasing of pre-LASIK intraocular pressure and cornea flap thickness (P<0.01). CONCLUSION: In one year follow-up, femtosecond laser can provide better cornea flaps with stable cornea biomechanics than mechanical microkeratome.     

MORIA SBK、90、110刀头切削角膜瓣的厚度变化及相关因素分析

目的探讨使用MORIA公司SBK、90、110刀头切削角膜瓣的厚度变化及相关影响因素。方法收集行准分子激光角膜原位磨镶术（LASIK）治疗的近视患者90例180眼,按术中使用刀头的不同分为SBK、90、110刀头组,每组30例60眼,均先右眼后左眼施行手术。术中测量角膜床厚度,对3组间角膜瓣厚度的差异进行比较,对角膜瓣厚度与年龄、屈光度、角膜厚度、曲率、角膜横径的相关性进行分析。结果 3组患者和手术眼的基线资料特征比较差异无统计学意义（P〉0.05）。SBK刀头组右眼和左眼的角膜瓣厚度分别为（97.50±11.39）μm和（96.73±10.45）μm,差异无统计学意义（P〉0.05）。逐步回归分析证实,SBK刀头组角膜瓣厚度与术前角膜厚度呈正相关（r=0.490,P=0.000）、与角膜横径呈负相关（r=-0.520,P=0.001）。在90刀头组中,患者右眼和左眼的角膜瓣厚度分别为（128.03±12.03）μm和（123.40±12.38）μm,差异有统计学意义（P〈0.01）。角膜瓣厚度与术前角膜厚度呈正相关（r=0.430,P=0.000）,与年龄呈负相关（r=-0.360,P=0.002）。110刀头组患者右眼和左眼的角膜瓣厚度分别为（140.53±15.14）μm和（135.23±18.03）μm,差异有统计学意义（P〈0.01）,角膜瓣厚度与术前角膜厚度呈正相关（r=0.710,P=0.000）。结论 MORIA角膜刀切削的角膜瓣厚度与术前角膜厚度有关,SBK刀头切削的角膜瓣厚度变异最小而110刀头者最大,LASIK术中用SBK刀头和90刀头能制作超薄或较薄的角膜瓣。术中应测量角膜床厚度,及时调整治疗方案,避免术后产生继发性圆锥角膜。     

Corneal flap measurements in laser in situ keratomileusis using the Moria M2 automated microkeratome

PURPOSE: To evaluate accuracy and predictability and factors that influence the dimensions of the laser in situ keratomileusis (LASIK) corneal flap created with the Moria M2 automated microkeratome (Moria SA, Antony, France). METHODS: The flap thickness of 454 eyes of 243 consecutive patients was measured using subtraction ultrasonic pachymetry during LASIK with the Moria M2 microkeratome head 130 designed to create a 160-microm-thick flap. Flap dimensions were evaluated and measurements were correlated with preoperative parameters. A stepwise regression analysis was used to determine the factors that influenced actual flap thickness. RESULTS: The preoperative spherical equivalent refraction of the 454 eyes ranged from -12.125 diopters (D) to +6.25 D. Patient age ranged from 18 to 57 years (mean age: 31.3 +/- 8.8 years). Mean preoperative keratometric power K1 was 44.31 +/- 1.59 D and K2 was 43.32 +/- 1.54 D. Mean preoperative central comeal thickness was 552.4 +/- 32.5 microm (range: 466 to 665 microm). With an attempted thickness of 160 microm, the Moria M2 flap thickness ranged from 77 to 209 microm (mean: 153.3 +/- 19.0 microm). Mean horizontal flap diameter was 9.2 +/- 0.2 mm and mean hinge length 4.6 +/- 0.3 mm. Increasing flap thickness was found to correlate with increasing preoperative comeal thickness, younger patient age, and flatter preoperative keratometric power K1. CONCLUSIONS: Although the standard deviation of the flap thickness was relatively small, remarkable individual variation was noted. Therefore, the intraoperative calculation of the remaining stromal bed is recommended. Furthermore, the consideration of central corneal thickness, patient age, and preoperative keratometry are helpful parameters to avoid too deep ablation.     

Moria M2微型角膜刀用常规刀片及Med—Logics 0号刀片制作LASIK角膜瓣的评估

背景角膜瓣的制作是准分子激光角膜原位磨镶术（LASIK）成功的关键步骤之一,随着微型角膜刀刀片技术的不断发展,其制作角膜瓣的精确性、均一性以及重现性已引起临床医师的广泛关注。目的比较MoriaM2微型角膜刀110刀头应用Med—Logics 0号刀片（110—0）及常规刀片（110）制作LASIK角膜瓣的特点。方法前瞻性研究。对近视患者102例204眼行LASIK,其中MoriaM2微型角膜刀110刀头应用Med—Logics0号刀片组（110—0组）及常规刀片组（110组）制作角膜瓣的患者各51例102眼。术后1周,应用RTVue傅里叶光学相干断层扫描（OCT）分别测量2组患者每个角膜上0°、45°、90°和135° 4条子午线所在截面上特定7个点的角膜瓣厚度,并对每个角膜瓣上28个测量点的角膜瓣厚度值进行对比分析。结果术后1周,110—0组和110组间裸眼视力和残余等效球镜度的差异均无统计学意义（视力：Z=-0．375,P=0．708;球镜度：u=0．056,P=0．956）。110—0组全角膜厚度为（133．28±15．41）μm,明显低于110组的（142．81±10．07）μm,差异有统计学意义（u=-5．227,P〈0．01）,并且110—0组与Moria公司提供的角膜瓣预期厚度值130μm更接近。2组制作的角膜瓣均为中间薄、周边厚,形状近似一凹透镜,并且2组右眼鼻侧和颞侧角膜瓣厚度比较差异均无统计学意义（P〉0．05）;左眼鼻侧均明显厚于颞侧,差异均有统计学意义（P〈0．05）。110—0组与110组角膜瓣厚度值与预计厚度130μm的差值分别为（17．46±2．28）μm和（16．82±6．12）μm,差异无统计学意义（u=0．517,P=0．608）。结论与110组比较,110—0组角膜瓣的厚度更薄,全角膜瓣厚度平均值与Moria公司提供的角膜瓣预期厚度值130μm更接近,其角膜瓣的均一性和预测性相对更好一些。     

Reproducibility of corneal flap thickness in LASIK.

BACKGROUND: The purpose of the microkeratome in laser assisted in situ keratomileusis (LASIK) is to create a corneal flap of desired thickness, thus exposing the stroma. The accuracy and repeatability of intended flap thickness with the current microkeratome system has not been documented. The purpose of this study was to determine the precision and consistency of creating a corneal flap thickness of 160 microns with the Moria LSK-One microkeratome (distributed by Microtech, Inc., Doylestown, PA). PATIENTS AND METHODS: The records of 93 eyes from 67 patients who underwent LASIK were reviewed. The central corneal thickness was measured at baseline. The microkeratome using a "130" footplate was used to create an intended flap 160 microns thick, and the corneal thickness was then remeasured. RESULTS: The mean flap thickness for both eyes combined was 159 microns (S.D. = 28). There was no significant correlation between pre-flap corneal thickness or average K and the corneal flap thickness. CONCLUSION: This study provides evidence that the Moria LSK-One microkeratome creates reproducible LASIK flaps consistently near the intended 160 microns corneal flap thickness. This knowledge enables the surgeon to make a corneal flap with great confidence in the thickness of the excision. In addition, this study provides a clinical, in vivo model for testing corneal flap thickness.     

Very high-frequency digital ultrasound measurement of the LASIK flap thickness profile using the IntraLase femtosecond laser and M2 and Carriazo-Pendular microkeratomes

PURPOSE: To evaluate the corneal aberrometric outcomes and corneal flap thickness profile after LASIK using three different devices for lamellar keratotomy: Moria M2 microkeratome, SCHWIND Carriazo-Pendular microkeratome, and IntraLase femtosecond laser. METHODS: Sixty-six myopic eyes of 33 patients who underwent LASIK with the SCHWIND ESIRIS excimer laser were enrolled in this study. Lamellar keratotomy was performed using three different devices that were assigned randomly to each patient: the Moria M2 microkeratome, SCHWIND Carriazo-Pendular microkeratome, and IntraLase femtosecond laser. The intended flap depth was 110 microm in all cases. Flap thickness profile, corneal aberrations, contrast sensitivity, and refractive outcomes were evaluated. RESULTS: Mean central flap thickness was 117.50 +/- 7.80, 118.08 +/- 8.34, and 115.95 +/- 6.22 microm for the M2, Carriazo-Pendular, and IntraLase systems, respectively. No significant differences were found among the groups. Nasal thicknesses were significantly larger for the M2 flaps compared to IntraLase (P < .05) and Carriazo-Pendular flaps (P = .046 only at 3-mm position). Temporal thicknesses were larger for the M2 flaps, although only differences between M2 and Carriazo-Pendular flaps reached statistical significance. Larger superior and inferior thicknesses were also observed for M2 flaps, although no statistically significant differences were found. Regarding corneal aberrometry, no statistically significant differences were observed in coma-like (P = .138) and spherical-like root-mean-square (P = .300). CONCLUSIONS: The M2, Carriazo-Pendular, and IntraLase systems create flaps of predictable thickness during lamellar keratotomy in LASIK. Additionally, the Carriazo-Pendular and IntraLase devices create flaps with a planar profile.