1. 90, 100 & 110 Micron Flap Using Small Bubble Femtosecond Laser
Scott M. MacRae MD Professor of Ophthalmology
Professor of Visual Science
University of Rochester
Dr. MacRae is a paid consultant to
Ziemer

2. Purpose: Compare Outcomes 90 vs 110 Micron Ziemer LDV Flaps
25 Eyes in each group
Mean SE
90 micron group: D Sph D Cyl.
110 micron group: D Sph D Cyl.

3. Visual Results: 90 vs 110 Micron LDV Flaps – 3 Months Postop
90 Micron Postop:
SE D D
Sph. -O.01
Cyl D
Mean UCVA (20/20)
Mean BCVA (20/16)
92% of eyes D of Plano
90 & 110 Micron Flaps obtained similar results
110 Micron
SE D D
Sph D
Cyl D
Mean UCVA (20/20)
Mean BCVA (20/16)
96% of eyes D of Plano

4. Univ. of Rochester/Ziemer
LDV Nomogram
Univ. of Rochester/Ziemer
Keratometry Readings
White to White
Ring Size
Hinge Width
90 µm flap
100 & 110 µm flap
Steep K’s >46.5
11.5 & smaller
9.0mm
0.5 mm
Steep K’s > 46.5
11.5 & larger
9.0
0.5
Average K’s
Average K’s
11.5 and larger
Flat K’s <42.00
11.5 and smaller
0.6
9.5

5. LDV Optimal Flap Management
Control hydration – Dry LASIK
Control flap thickness Ziemer:
Dry ultrasound flap measurements reduces Standard Deviation
LDV 110 µm µm
LDV 90 µm µm
Working at “Five sigma”
Position flap optimally “as if it never moved”
90 micron:
More delicate, drier – “potato chip
Hourly prednisolone acetate day of surgery, no rainbow glare or haze compared to IL
Stretch flap in “Butterfly Technique”, no microstria

6. Intraoperative Pachymetry: Dry Method- Dry Before First Measurement

7. Ziemer LDV Smaller Spot Size “Small Bubble” Strategy
Less energy concentrated in one area
Similar to spreading laser spots out with femto – reduces thermal energy and cavitation
Cavitation rare
No Transient Light Sensitivity Syndrome
No rainbow glare, haze reactions
No Opaque Bubble Layer

8. Advantages of Ziemer LDV Femtosecond Small Spot Strategy
Thin flap - 90 µm strategy allows LASIK treatment thin corneas previously needing PRK
Minimal or no risk of cavitation, inflammation, haze, or rainbow glare
Allows deeper Rx with pockets, tunnels or deep lamellar RX without using high energy again reducing inflammation and corneal edema

9. 90 Micron LDV Femto Small bubble technology:
Makes epithelial breakthrough much less likely
Opaque Bubble Layer (OBL) minor issue with LDV
Start conservatively and handle like a EpiLASIK flap
Patients appreciate avoiding PRK!

10. New Ziemer LDV 100 Micron Interspace Shields
Best of both worlds
LDV 100 µm µm
My Preferred flap thickness
Minimizes PRK
Easy to handle and greater comfort factor than 90 microns.
Use same settings as 110 microns
Flaps behave like 110 micron flaps
Allows transition to 90 microns when needed with greater confidence
Still use 90 microns confidently in to optimize thin flap strategy

11. Summary 90, 100 & 110 Micron Flaps with Ziemer LDV
Outcomes Similar for 90 and 110 microns
Flap thickness Ziemer LDV:
LDV 110 µm µm
LDV 90 µm µm
LDV 100 µm µm
Working at “Five sigma”
Small Bubble technology allows thinner flaps while avoiding inflammation