All-Laser LASIK, iLASIK, IntraLASIK for The Total Laser Experience
A Rose by Any Other Name Would Look as Sweet.
Call it by any of the terms above, iLASIK, IntraLASIK, or All-Laser LASIK, but what it refers to is the total laser LASIK procedure, where instead of a mechanical (bladed) microkeratome a femtolaser microkeratome is used to make the corneal flap. Once the flap is rolled back, conventional or wavefront LASIK ensues. The process is completely bladeless, and seems to have some advantages over its sharpened counterpart: It's said to be more accurate, with more precise positioning of the corneal flap, reported to create flaps with a more even thickness and as thin as 100 microns (mechanical or bladed microkeratomes generally achieve 140-180 microns thick), and reduce the chance of intra- and postoperative complications.
The Procedure:
The laser emits quick pulses through the outer layer of the cornea, moving in a grid pattern back and forth over the eye, perforating it and creating microscopic bubbles in the cornea at a specific depth. The bubbles coalesce, forming a pocket or space which is then incised (by laser) around its circumference though leaving a small hinge attached, thus creating a flap that can be drawn back to expose the lower tissues. The surgeon then may continue with either a conventional or a wavefront LASIK vision correction procedure. After the treatment, the flap is gently replaced, as in other forms of LASIK.
With all-laser LASIK, the surgeon can control the location of the corneal flap's hinge, something a mechanical keratome cannot do. This allows for greater customization of the corneal flap, permitting the hinge to be created perhaps in a slightly thicker portion of the cornea, providing for greater intra- and postoperative stability.
Since the flap can be made exceptionally thin, people with thinner corneas may become viable candidates for LASIK, where once this quality would have disqualified them for the procedure.
Because metal blades might create uneven or thinner flap edges, they can result in abnormal corneal surfaces and vision defects such as irregular astigmatism. Other issues like "buttonhole" or incomplete flaps, which may cause scarring, have been associated with the use of metal keratome blades. The laser leaves more exact edges to the corneal flap, reportedly lessening the risk of these types of complications.
Complications:
Generally, just a few complications have been reported. Some patients experience increased swelling of the corneal tissues, causing temporarily blurred vision, however this usually disappears as the eye heals. Sometimes there can be superficial bleeding on the white of the eye caused by the vacuum's suction being in contact for a slightly longer period of time than with the traditional keratome. This is temporary and not vision-threatening.
There can be an increased risk of post-operative photophobia, which is temporary, resolving within a few weeks with eye drops (steroid drops). This is also not a vision-threatening complication. Finally, some patients have reported a rainbow effect around light sources, but this is not common.
Though studies generally seem to show an overall lower risk of complications with all-laser LASIK when compared to LASIK performed with a mechanical microkeratome, some surgeons report incidences of complications similar to those using the bladed method.
Since this procedure is relatively new with about 10 years of practice in the U.S., only time and further studies will show decisively whether the all-laser approach will be found superior to the bladed approach. Recent developments in the mechanical microkeratome, allowing for greater control and thinner flaps may give the lasers a run for their money, keeping overall costs for LASIK lower and quality of treatment high.
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