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Precision of a Manually Guided Microkeratome with Various Corneal Cut Depth

1Lackerbauer C., 1Ullrich S., 1Priglinger S., 1Bechmann M., 2Ludwig K.,
1Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Augenklinik (München)
2Augenklinik der Ludwig-Maximilians-Universität München (München)

Purpose: The microkeratome is an important component of laser in situ keratomileusis (LASIK) and lamellar keratoplasty (KP). In particular accuracy and reproducibility of the intended corneal flap thickness is most significant. To compare intended to real corneal flap thickness by using a microkeratome with various cut depth is the purpose of this study.
Method: Using a manually guided microkeratome (model: LSK-one, Moria, France) a lamellar keratectomy was performed with different cut depth (150µm, 200µm, 250µm, 300µm, 350µm) in 100 pig eyes. Using optical coherence tomography (OCT; Zeiss/Humphrey, San Leandro.Ca, USA) corneal thickness was calculated by three well trained and independent reader close to and after lamellar keratectomy. Results of the reader were correlated (spearman rank correlation; rho, p<0,05). Real and intended corneal flap thickness was considered statistically (paired t-test; p<0,05).
Results: The OCT results of all reader show a high correspondence (150µm (rho: 0,89; p=0,0002), 200µm (rho: 0,87; p=0,0005), 250µm (rho: 0,93; p=0,0002) 300µm (rho: 0,94; p=0,0001) and 350µm (rho: 0,87; p=0,0006). With an intended 150µm cut depth mean corneal flap thickness is 144µm±34 (p=0,47); with an intended 200µm cut depth mean corneal flap thickness is 221µm±38 (p=0,14); with an intended 250µm cut depth mean corneal flap thickness is 262µm±30 (p=0,097); with an intended 300µm cut depth mean corneal flap thickness is 295µm±45 (p=0,665) and with an intended 350µm cut depth mean corneal flap thickness is 374µm±54 (p=0,07). Differences between intended and real corneal thickness of all various cut depth shows no statistic significance.
Conclusions: In all different cut depth the microkeratome LSK-one shows a high accuracy and reproducibility of the intended corneal flap thickness. Because of the manual guide the microkeratome makes a great demand on the surgeon.