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 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

Moria One Use-Plus keratome with metal ring 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

Moria One Use-Plus keratome Single Use heads 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 130 head (for 130-µm flaps)

Settings One Use Plus with 130 head and metal ring 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

Methods One Use Plus with 130 head and metal ring Flap thickness by subtractive pachymetry Flap dimensions measured with calipers Complications reported intraop and postop

Results Flap Thickness One Use Plus with 130 head and metal ring Microkeratome head Speed Average Thickness Range 130 µ 2 (Fast) 123 +/- 12 µ 97 to 149 µ

Results Flap Thickness versus Preop pachymetry Flap thickness (microns) Preop pachymetry (microns) n =68

Results Vertical Flap Diameter Hinge size One Use Plus with 130 head and metal ring 9.9 mm ± 0.25 min 9.0 max 10.25 5.11 mm ± 0.56 min 4 max 6.5 Flap Diameter Hinge size

Results Complications Button-hole Free cap Irregular flap Thin flap requiring BCL Epithelial sloughing DLK Epithelial ingrowth Microstriae Bleeding 3 25

Results Flap and bed quality 28/68 eyes Centration 95 % excellent Edge quality 60 % excellent Shape of the flap 100 % excellent Bed quality 96 % excellent

Moria One Use Plus with metal head Conclusion Moria One Use Plus with metal head My keratome of choice in LASIK Excellent flap thickness predictability Excellent safety profile Ongoing study with 90 Head