Microkeratome vs. Intralase

Q: Is intralase any safer than microkeratome? I am a perfect candidiate for lasik. I am myopic and have a slight astigmatism. Should I be worried about the micokeratome blade?

A: For your questions about microkeratome safety, in short – you should not worry. There are a lot of elements that contribute to or enhance the safety of a LASIK procedure. Beyond the fact that all lasers are not created equal (I just found one on the ebay for $2,500!) and not to mention the contributions to accuracy that the new wavescans bring.

Here are some of the differences in flap thickness and methodology of the procedure. Dr. Khanna has preferred the “cut” from the microkeratome blade as a”cleaner” more even cut than that from a series of laser pulses. A smoother cut would indicate a cleaner heal and less chance of post-operative halos, due to less light refraction from the ridge.

The following is from a report published in Ophthalmology Management (April 06) documenting the results of one study:

“Sanjay V. Patel, M.D. and a team from the Mayo Clinic in Rochester, Minn., performed LASIK for myopia or myopic astigmatism on 20 patients. For each patient, the flap for one eye was cut with a Hansatome microkeratome (Bausch & Lomb, Rochester, N.Y.) and the flap for the second eye was cut with the IntraLase FS (IntraLase Corp., Irvine, Calif.).

Visual results were measured comprehensively at 1, 3 and 6 months following surgery. Patients were also asked if they preferred the vision in either eye.
Researchers found corneal backscatter higher in the IntraLase eye at 6 months, but no difference in high-contrast visual acuity and contrast sensitivity. At 3 months following surgery, seven patients preferred the microkeratome eye, five patients preferred the IntraLase eye and eight had no preference. Researchers concluded that there was no significant difference in vision perceived by patients between the two flap-cutting methods.”

I’d go with the preferece of the doctor.

The thickness of the flap can also be an issue, whereas a standard LASIK flap may have a deeper penetration into the cornea. These flaps may range between 100 and 160 microns. A shallower flap will reduce the effect on the eyes structural integrity, better for higher astigmatisms and patients with thin corneas, but may increase the instance of post-operative haze. In both of these cases there is a slight risk of flap complication due to tearing, slippage or separation of the flap after the surgery.

Dr. Khanna specializes in a 50 micron deep SUPERLASIK procedure that uses an epi-keratome. This method separates the top epithelial layer without cutting a flap! This procedure reduces if not eliminates the risk of most flap complications.

Written by Rajesh Khanna, MD

Los Angeles Lasik Surgeon Rajesh Khanna MD is a recognized pioneer in Presbyopic Implants for correction of aging eyes. He has popularized Cornea Cross Linking and Intacs forKeratoconus. He is an Expert Cataract, Pterygium Eye Surgeon, A Cornea Specialist he performs Laser Corneal Transplants, DMEK, DSEK and DALK. Rajesh Khanna MD is a well known medical writer. He has published the bestseller "The miracle of Pi in Eye".He is also a columnist for the newspaper Acorn. Dr.Khanna also hosts "Medical Magic". In his spare time he hikes with his family and German Shepard or does yoga. He also plays field hockey and loves swimming.