All Laser LASIK
Intralase Blade-Free LASIK
Although the complication rate for LASIK is low, 1% or less, most complications are flap-related rather than laser-related. Flaps that are too thin, irregular, incomplete, contain a “button hole,” or contain a large area of loose or abraded epithelium may give suboptimal results or may cause the surgeon to abort the laser step completely. The precision of a flap created by a laser, rather than a microkeratome with a steel blade, may greatly reduce or even eliminate serious flap problems. The IntraLase Corporation of Irvine California received FDA approval for its femtosecond laser about three years ago, and is now the preferred method in our practice for making the flap in LASIK. The laser pulses, each lasting one quadrillionth of a second (femtosecond), are programmed to pass harmlessly through the surface of the cornea and create a flap of predetermined thickness. As with the standard mechanized microkeratome, a small hinge of tissue remains uncut, forming an area where the flap can be folded out of the way so that the excimer laser can reshape the cornea.
The entire IntraLase flap procedure takes less than thirty seconds, and with the use of standard anesthetic drops, is painless. There are several advantages to the IntraLase system. Flap thickness is generally more precise and predictable than with a microkeratome, where flap thickness can vary by 20ì to 30ì or more. Some patients with borderline cornea thickness may become eligible for IntraLase LASIK rather than PRK because the femtosecond laser can be programmed to make a thinner flap, leaving behind more residual corneal tissue.
With IntraLase, the likelihood of epithelial abrasion and incomplete flaps is greatly reduced, though not totally eliminated, because there is less friction on the cornea with IntraLase than with a microkeratome blade. Patients with surface cornea problems, such as basement membrane dystrophy, might become eligible for LASIK if the flap is made with a laser rather than a blade.
Another advantage of the IntraLase procedure is a more uniform flap thickness that may better fit into the cornea following laser ablation like a manhole cover into the street. IntraLase does not eliminate other flap problems, such as stria and folds.
Although there are advantages to the IntraLase, the long-term safety record of a standard micokeratome and its continued success for millions of patients may justify its use by LASIK surgeons.