LASIK with thin flaps using the Moria One Use-Plus microkeratome with the 130 disposable heads Jérôme C. VRYGHEM, M.D. Brussels Eye Doctors Brussels, Belgium.

LASIK with thin flapsusing the

Moria One Use-Plus microkeratomewith the 130 disposable heads

LASIK with thin flapsusing the

Moria One Use-Plus microkeratomewith the 130 disposable heads

Jérôme C. VRYGHEM, M.DJérôme C. VRYGHEM, M.D..

Brussels Eye DoctorsBrussels Eye Doctors

Brussels, BelgiumBrussels, Belgium

Jérôme C. VRYGHEM, M.DJérôme C. VRYGHEM, M.D..

Brussels Eye DoctorsBrussels Eye Doctors

Brussels, BelgiumBrussels, Belgium

No financial interest

Advantages of Thin Flaps

Cut through more superficial layers of the cornea More solid texture: less tendency to form tension lines/wrinkle The large corneal nerves trunks are below:

corneal sensation – more intact less dry eyes

Less epithelial defects The thinner the flap, the less epithelial trauma Plastic is more gently to the epithelium

Thicker residual corneal bed Greater safety: Further away from the 250 µm ectasia barrier More possibilities:

Thinner corneas can be treated Larger optical zones if needed can be treated Enhancements still possible without going too thin

• Ergonomic, pre-assembled and one-handed usage possible

• Metal suction ring• 4 stops (7.5, 8, 8.5, 9) to change hinge size

• 4 metal ring sizes to fit all keratometries (-1, 0, +1, +2)• 2 motors, one for blade oscillation, one for advancement

with metal ring

Moria One Use-Plus keratome

Single Use heads

130 head(for 130-µm flaps)

Moria One Use-Plus keratome

• Sterile device– Potentially lower incidence

of DLK– Decreases risk of

transmission of disease• Translucent head

– Makes it easier to visualize placement on the suction post

• Easy to assemble– No risk of blade damage

during assembly

Settings

One surgeon: Dr. J. C. Vryghem Private clinic: Brussels Eye Doctors Wavelight Allegreto laser for excimer ablation

Prospective study in 68 eyes of 34 patients 2 months in 2007

One Use Plus with 130 head and metal ring

Methods

Flap thickness by subtractive pachymetry Flap dimensions measured with calipers Complications reported intraop and postop

One Use Plus with 130 head and metal ring

Results Flap Thickness

• Microkeratome head

• Speed

• Average Thickness

• Range

130 µ

2 (Fast)

123 +/- 12 µ

97 to 149 µ

One Use Plus with 130 head and metal ring

Results Flap Thicknessversus Preop pachymetry

80

90

100

110

120

130

140

150

160

170

180

450 475 500 525 550 575 600 625 650

Preop pachymetry (microns) n =68

Fla

p th

ickn

ess

(mic

rons

)

9.9 mm ± 0.25 min 9.0

max 10.25

Flap Diameter

Results Vertical Flap DiameterHinge size

One Use Plus with 130 head and metal ring

5.11 mm ± 0.56 min 4

max 6.5

Hinge size

Results Complications

• Button-hole• Free cap• Irregular flap• Thin flap requiring BCL• Epithelial sloughing• DLK• Epithelial ingrowth• Microstriae• Bleeding

0

0

0

0

3

0

0

25

n = 68

Results Flap and bed quality

• Centration 95 % excellent

• Edge quality 60 % excellent

• Shape of the flap 100 % excellent

• Bed quality 96 % excellent

28/68 eyes

Conclusion

My keratome of choice in LASIK Excellent flap thickness predictability Excellent safety profile

Ongoing study with 90 Head

Moria One Use Plus with metal head