The advent of the femtosecond laser

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From the first clinical use of a photodisruptive laser (pico second) for vitreous lysis to more than 1800 systems now installed worldwide and three and a half million surgeries having been conducted Dr Joseph Colin talks us through how far things have come.

The advantages of using a femtosecond laser to create a LASIK flap significantly outweigh those associated with a mechanical microkeratome, according to France’s Dr Joseph Colin and colleagues who marked an ESCRS ophthalmic milestone at today’s main symposia in Paris celebrating the 20th anniversary of LASIK.

The femtosecond laser LASIK flap creation has been available to doctors for 10 years and since its introduction considerable progress has been made in improving flap geometry and limiting complications, which has made it increasingly popular, with more than 1,800 systems installed worldwide and, according to Dr Colin, more than 3,500,000 surgeries have been done. He also indicated that between 30-50% of LASIK procedures in the US conducted in 2008 were done using a FS laser.

He told delegates about a recent study in the Journal of Refractive Surgery in January 2010 which found that FS lasers cut thinner LASIK flaps than intended. In that study 405 patients (787) underwent LASIK using the FEMTO LDV femtosecond laser . Although flaps were thinner than intended (90µm v intended 110 µm), standard deviation was very low (5.0 µm for all eyes) and intraoperative complications were minimal, with minor bleeding being the most common (12.1%). Also, increasing flap thickness was correlated with increasing corneal thickness in right eyes and flatter keratometric value in left eyes and mean flap diameter (approximately 9.1mm in both eyes) was correlated with higher keratometric value. The study’s authors concluded that LASIK with a femtosecond laser appears to be a predictable and safe procedure for the creation of think flaps in LASIK, but warned that the transition from mechanical microkeratomes to femtosecond lasers can b e a tough one for less experienced surgeons.

The ESCRS also announced the launch of a new consumer website www.LASIKSafeInOurHands.com aimed at providing the general public with education about the procedure and addressing the concerns those who have not previously considered the procedure.

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