Journal of Refractive Surgery Volume 23 February 2007
Confocal Microscopy Comparison of IntraLase Femtosecond Laser and Moria M2 Microkeratome in LASIK
Jaime Javaloy, MD, PhD; Mar?a T. Vidal, MD, PhD; Ayman M. Abdelrahman, MD; Alberto Artola, MD, PhD; Jorge L. Ali?, MD, PhD
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The first 20 consecutive eyes in 10 patients of each group were studied using confocal microscopy.
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Grade I and II diffuse lamellar keratitis (DLK) was observed in 16 eyes of the femtosecond laser group at 1 week postoperatively. In an additional case in the same group, grade III DLK developed, which impacted refractive outcome. None of the eyes operated using the mechanical microkeratome developed DLK (chi square=15.75, P.001).
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The significantly higher wound healing opacity index found for the eyes operated with the femtosecond laser in our study can be explained by taking into account two features: deeper cuts were performed with the M2
microkeratome and a greater degree of inflammation was observed in the femtosecond laser group (demonstrated by a higher incidence of DLK), which produced a greater activation of anterior keratocyte population.
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Diffuse lamellar keratitis consists of a multi-etiologic syndrome that expresses variable degrees of inflammation at the interface of eyes operated by LASIK.37,38 As DLK after LASIK using a femtosecond microkeratome has not been reported previously, the 17% prevalence rate of this syndrome (even considering that just 6.25%?1 case?was greater than grade I or II) in our series has to be taken into account.
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A retrospective analysis of the first 100 eyes (not included in the present study) after the energy reduction revealed a decrease in the incidence of DLK to 3% (grade I or II). For this reason, we believe that the incidence of DLK after using the femtosecond laser is related to the intensity of the energy used for the lamellar or side cut.
