#sharpersurgicalsight

What is a Microkeratome? A epikeratome is a surgical device used in laser eye surgery procedures such as LASIK (laser-assisted in situ keratomileusis). It consists of an adjustable blade attached to an oscillating arm. The purpose of the epikeratome is to carve a thin flap in the outer layer of the cornea called the epithelium. This flap is then folded back to expose the underlying stroma layer. The Stages of Epikeratome Use There are three main stages when a epikeratome is used in LASIK eye surgery:

Creation of the corneal flap: The surgeon lowers the epikeratome blade onto the center of the cornea and it uses an oscillating mechanism to carve a very thin flap. The blade depth and width are adjustable to suit each patient's needs. Most flaps are between 100-150 Microkeratom thick.

Flap lifting: Once the flap is cut, it is gently lifted at its hinge point using a spatula. This exposes the stroma layer.

3. Laser treatment: An excimer laser is used to reshape the stroma by removing tiny portions of tissue. This corrects refractive errors like myopia, hyperopia and astigmatism. Once the laser treatment is complete, the corneal flap is reversibly replaced over the stroma. It adheres naturally and no sutures are required. The epithelium then regrows under the flap within a few days. How the Epikeratome Improves Laser Refractive Surgery Earlier refractive procedures relied on manual dissection using a microsurgical knife to cut the corneal flap. However, the epikeratome automates and standardizes this process using its patented oscillating mechanism. Some key benefits are: 1. Consistent and accurate flap thickness: The oscillating arm cuts a uniform thickness flap each time, from 100-150 microns. Manual blades can vary more. 2. Minimal corneal burn: The epikeratome exerts less friction heat compared to manual cutting. This reduces damage to corneal nerves. 3. Smooth surface and edges: The oscillation leaves the inner stromal bed and flap edges ultra-smooth. Manual blades are rougher. 4. Higher success rates: The standardized epikeratome flaps translate to fewer complications and higher refractive predictability with the laser treatment. comparable results across surgeons and clinics worldwide. Factors Affecting Flap Creation While epikeratomes have automated and improved LASIK flap creation, not every case is straightforward. Some factors that can influence how the flap is cut include: 1. Corneal thickness and diameter: Thinner or smaller corneas may be at risk of complications like unpredictable flap size. 2. Corneal properties: Conditions that alter corneal rigidity like keratoconus or ectasia increase chances of irregular flap. 3. Epikeratome settings: Incorrect blade oscillation speed, angle or depth settings cannot produce optimal results. 4. Surgeon technique: Proper epikeratome handling, alignment and application technique are critical. 5. Mechanical errors: Rare issues like wiring faults or bearing problems in the epikeratome itself may cause deviations. Careful patient assessment and epikeratome settings based on corneal tomography can maximize success rates despite the above risks in difficult cases. Overall, modern epikeratomes deliver very consistent flap cuts in routine LASIK. Impact on LASIK Outcomes The introduction of epikeratomes revolutionized LASIK by automating flap creation and improving procedural predictability. Some key impacts on refractive surgery outcomes are: - Higher accuracy: Consistent 100-150 micron flaps allow excimer lasers to ablate the stroma more accurately as planned. - Better safety:Smoother flaps and beds minimize problems like uneven healing, large epithelial ingrowths or long-term corneal haze.