Effects of Variation in Depth and Side Cut Angulations in LASIK and Thin-flap LASIK Using a Femtosecond Laser: A Biomechanical Study

PURPOSE: To study the corneal biomechanical effects of varying LASIK flap depth and side cut angulations and evaluate the relative contribution of the lamellar and side cuts using a femtosecond laser and radial shearing speckle pattern interferometry (RSSPI). METHODS: Forty-two organ-cultured human corneas were divided into a control group and three investigative groups, each undergoing different incision types at both 90- and 160-mu m depth using a femtosecond laser. In the first group, typical LASIK flaps were created; in the second group, only the bed was cut (delamination); and in the third group, side cuts alone were affected. Corneal strain was measured using RSSPI before and after treatment following an increase in hydrostatic pressure from 15.0 to 15.5 mmHg and again after 1 week of incubation in culture medium. RESULTS: The flap group demonstrated a weakening of strength related to the depth of cut, with strain increasing by 9% and 32% at 90 and 160 mu m, respectively. Similar changes, 9% and 33%, were observed following execution of side cuts to the same depths. By contrast, strain increase following delamination showed no relationship with depth, increasing by 5% in both instances. When the side cut angle was made more acute, strain decreased with a 2% strain increase being measured after a 90-mu m, 150 degrees side cut was created. No significant changes occurred during the period of organ culture. CONCLUSIONS: Vertical side cuts through corneal lamellae rather than horizontal delamination incisions contribute to the loss of structural integrity during LASIK flap creation. Angulating side cuts such that the stromal diameter of the flap exceeds its epithelial diameter can decrease this effect. [J Refract Surg. 2012;28(6):419-425.] doi:10.3928/1081597X-20120518-07