Microkeratome versus Femtosecond Laser
Two methods are used to form a LASIK flap: 1) microkeratome (MK) or 2) femtosecond laser (FL: Zeiss Visumax™, Intralase™ , Z-LASIK ™. The LASIK procedure performed with a femtosecond laser is sometimes called “All-Laser LASIK,” “Bladeless LASIK,” or Z-LASIK ™.
The goals of flap formation are a smooth bed, consistent flap thickness, flap hinge away from the treatment area, and safety with no damage to the flap. Both methods can accomplish this. Current MK’s are 5th generation devices and are extremely safe compared to the earlier instruments. The MK creates a smooth bed, but requires more surgeon experience than the FL. The FL flap creates a more uniform flap thickness, but is slightly slower than MK with more tissue adhesion.
Studies show that results using the FL flap are more consistent than those obtained with the MK, with a lower complication rate. However, no procedure is complication free, and flap complications can occur whether created with the laser or MK.
Numerous studies have compared the MK with FL, and most show better results with FL. Evidence suggests that thinner flaps result in better visual performance for patients. Dr. Roholt realized this several years ago and consistently achieves 90-100 um flaps even with MK. While the MK flap has rapid visual recovery, excellent bed smoothness, and less interface inflammation, the FL is overall better for most patients.
At Roholt Vision Institute, the Zeiss Visumax™ and Ziemer femtosecond lasers (Z-LASIK) are used for Bladeless, All-Laser LASIK. The Ziemer is a second-generation, solid-state laser producing a more focused, faster treatment than the Intralase™ and is excellent for the KAMRA inlay. The Zeiss Visumax™ is an extremely low energy, accurate laser used for Z-LASIK flaps and is the only laser approved for the ReleX SMILE procedure.