Reproducibility of LASIK flap thickness using the Hansatome microkeratome

Purpose: To evaluate the actual versus the expected thickness of laser in situ keratomileusis (LASIK) flaps and to determine the factors that affect flap thickness. Setting: Centre For Sight, Queen Victoria Hospital, East Grinstead, United Kingdom. Methods: A retrospective analysis of LASIK procedures in 757 consecutive eyes was done. The surgery was performed by a single surgeon using 2 Hansatome(R) microkeratomes (Bausch & Lomb) with 160 mum and 180 mum heads. Patient age, preoperative manifest refraction, automated keratometry, preoperative central pachymetry, and intraoperative stromal pachymetry were evaluated to determine whether they influenced the actual flap thickness. Results: Bilateral LASIK was performed in 343 patients (686 eyes). The 160 mum head was used in 641 eyes (84.6%) (Group 1) and the 180 mum head, in 116 eyes (15.4%) (Group 2). The mean preoperative manifest refraction spherical equivalent (SE) was -3.9 diopters (D) +/-4.5 (SD) (range +7.4 to -25.0 D) in Group 1 and -4.4+/-3.7 D (range +7.1 to -12.9 D) in Group 2. The mean preoperative keratometry reading was 43.6+/-1.8 D (range 36.0 to 48.6 D) and 43.6+/-1.8 D (range 35.9 to 47.0 D), respectively; the mean preoperative central pachymetry was 543+/-35 mum (range 447 to 643 mum) and 548+/-31 mum (range 453 to 613 mum), respectively; and the mean flap thickness was 116.4+/-19.8 mum and 117.3+/-18.0 mum, respectively. The difference between the actual and the expected flap thickness in each group was statistically significant (P<.001). There was no significant difference in the actual flap thickness between the 2 Hansatomes. The preoperative SE and central pachymetry were the only factors that influenced the actual flap thickness (P<.05); thin flaps were more common with increasing myopia and increasing corneal thickness. Conclusions. Spherical equivalent and preoperative pachymetry were the principal factors that influenced flap thickness. Preoperative keratometry values and patient age did not influence the actual flap thickness.