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Getting thinner flaps with the Moria M2 microkeratome

Getting thinner flaps with the Moria M2 microkeratome. Juhani Pietilä, MD Petri Mäkinen, MD ESCRS Fall 2004, Paris Tampere, Finland. Background. A thin flap theoretically decreases the risk of cornea ectasia.

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Getting thinner flaps with the Moria M2 microkeratome

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  1. Getting thinner flaps with the Moria M2 microkeratome Juhani Pietilä, MD Petri Mäkinen, MD ESCRS Fall 2004, Paris Tampere, Finland

  2. Background • A thin flap theoretically decreases the risk of cornea ectasia. • However, the risk of flap irregularities, button holes and epithelial defects may increase when thinner flaps are created.

  3. Purpose • We compared the predictability of the flap thickness and possible flap related complications with different Moria M2 microkeratome heads.

  4. Moria M2 Characteristics • Hinge anywhere • Different suction rings for different K-values • Adjustable hinge length with different stop settings • Changeable heads to make thicker or thinner flaps

  5. M2 head characteristics targeted flap thickness • Metallic 130 head 160 m • Metallic 90 head 120 m • Plastic Single Use 130 head 160 m • Plastic Single Use 90 head 120 m

  6. Patients • 49 eyes with metallic 130 head (ME130) • 114 eyes with metallic 90 head (ME90) • 49 eyes with plastic 130 head (SU130) • 88 eyes with plastic 90 head (SU90)

  7. Technique • Suction ring selection using manufacturer’s nomogram based on the steepest K-reading, stop setting always 8.0mm • Superior hinge in all eyes • Excimer laser Carl Zeiss Meditec MEL 80 with active eyetracker

  8. Steepest K Ring Stop Flap diameter Stroma Available for Ablation Hinge Chord Length 40 -1 7.5 9 8.25 5.0 41 -1 8 9.25 8.625 4.6 0 7.5 8.75 8.125 4.5 42 -1 8 9.5 8.75 5.1 0 7.5 9 8.25 5.0 43 -1 8.5 9.75 9.125 4.8 0 8 9.25 8.625 4.6 1 7.5 8.75 8.125 4.5 44 0 8 9.5 8.75 5.1 1 7.5 9 8.25 5.0 45 0 8 9.5 8.75 5.1 1 7.5 9 8.25 5.0 46 2 7.5 8.75 8.125 4.5 M2 Nomogram

  9. Flap thickness (m) ME130 ME90 SU130 SU90 153.3 ±13.3 131.2 ±15.4 148.0 ±9.8 121.8 ±12.6 min 102 min 88 min 120 min 99 max 179 max 167 max 170 max 156 Results:

  10. Flap diameter (mm) ME130 ME90 SU130 SU90 9.06 ±0.20 9.10 ±0.17 9.01 ±0.20 9.06 ±0.18 min 8.3 min 8.3 min 8.3 min 8.5 max 9.5 max 9.6 max 9.4 max 9.5

  11. Hinge lenght (mm) ME130 ME90 SU130 SU90 4.21 ±0.27 4.20 ±0.21 4.22 ±0.23 4.16 ±0.22 min 3.3 min 3.5 min 3.7 min 3.2 max 4.6 max 4.7 max 4.8 max 4.7

  12. Corneal Thickness vs. Flap Thickness ME130 Flap Thickness, m ME90 Preop Pachymetry, m

  13. Corneal Thickness vs. Flap Thickness SU130 Flap Thickness, m SU90 Preop Pachymetry, m

  14. Complications ME130 ME90 SU130 SU90 % (n) % (n) % (n) % (n) • Free cap 0% 0% 0% 0% • Incomplete flap 0% 0% 0% 0% • Button-hole 0% 0% 0% 0% • Epithelial defect 2% (1) 0% 0% 0% • Bleeding 4% (2) 4% (2) 6%(7) 8%(7) • Iron particles 2% (1) 2% (1) 4%(4) 5%(4) • Flap wrinkles/striae 0% 2% (1) 0% 0% • Epithelium in the edge 2% (1) 0% 0% 0% • DLK 0% 0% 0% 0% • BCVA loss (2 lines, 1month) 0% 0% 0% 0%

  15. Conclusions • Complication rate did not increase when thinner flaps were created • Predictability was good with all microkeratome heads • Thin flaps recovered more rapidly (less flap swelling) • Low rate of microkeratome related complications with all heads • Single Use head minimizes the risk of infection • Plastic head works more smoothly

  16. Thank You

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