Abstract
Purpose To evaluate the specifications and technique properties of the new Femto LDV Z8 in creating intrastromal refractive lenticules during small incision lenticule extraction (SMILE). Methods Six enucleated porcine eyeballs were equally divided into two groups (Femto LDV Z8 or VisuMax) and were randomly assigned to three experienced refractive surgeons who performed SMILE on each group. Five intraoperative time parameters and surgeons' satisfaction on the surgical procedure were compared between two groups. Postoperatively, the roughness of the lenticule surfaces and the irregularity of edges were observed by scanning electron microscopy (SEM) and were also compared between the two groups. Results Longer time on suction peak pressure, total laser application, and total surgery were spent in the Femto LDV Z8 group as compared with the VisuMax group. The Femto LDV Z8 group applied OCT scanning and offsetting before performing the laser procedure, which expended more time for these crucial steps. The widest range of surgeons' satisfaction scores was found in the step of lenticule interface identification of the Femto LDV Z8 group. The roughness scores of the anterior and posterior lenticule surfaces were statistically less in the Femto LDV Z8 group than in the VisuMax group (anterior, ×180, p=0.039; anterior, ×250, p=0.337; posterior, ×180, p=0.006; and posterior, ×250, p=0.007). Conclusions Femto LDV Z8 showed promising performances as a novel SMILE equipment for the correction of myopia. It has special and unique features for SMILE procedures, which need more learning and researching processes. With its low-energy high-frequency nJ-level laser system, the Femto LDV Z8 provided smoother lenticule surface than VisuMax.
Highlights
Small incision lenticule extraction (SMILE) is a femtosecond laser procedure which was first performed using the VisuMax Laser System (Carl Zeiss Meditec AG, Jena, Germany). [1, 2] is no-flap surgery has shown promising long-term outcomes for the correction of myopic refractive errors similar to those of laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). [3,4,5] e Femto LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) is a high-frequency femtosecond laser system with a three-dimensional cutting mode
All the surgeons in this study had more than 10 years of refractive surgical experience, each of them having more than 1000 cases of FSLasik operations using Femto LDV Z6 and more than 500 cases of SMILE operations using VisuMax
Statistical comparison between the two laser platforms could not be performed due to a small number of population in this study; an obvious trend of longer duration in suction peak pressure, total laser application, and total surgical time can be observed with the Femto LDV Z8 group (8.3 ± 0.2 seconds, 51.0 ± 1.1 seconds, and 265.1 ± 11.3 seconds, respectively) as compared with the VisuMax group (2.0 ± 0.1 seconds, 21.4 ± 1.0 seconds, and 173.3 ± 7.6 seconds, respectively)
Summary
Small incision lenticule extraction (SMILE) is a femtosecond laser procedure which was first performed using the VisuMax Laser System (Carl Zeiss Meditec AG, Jena, Germany). [1, 2] is no-flap surgery has shown promising long-term outcomes for the correction of myopic refractive errors similar to those of laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). [3,4,5] e Femto LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) is a high-frequency femtosecond laser system with a three-dimensional cutting mode. [3,4,5] e Femto LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) is a high-frequency femtosecond laser system with a three-dimensional cutting mode. Studies by Pajic et al [6] and Ebner et al [7] documented that Femto LDV Z8 usually enables surgeons to perform customized flaps with adjustable selfsealing flap edges and hinges for femtosecond-LASIK procedures. It enables the spectrum of intrastromal tunnels for intracorneal rings (ICR), intrastromal pockets (ISP) for presbyopic inlay implantation, and intrastromal dissection for lamellar and penetrating keratoplasties, as well as capsulotomy and lens fragmentation for cataract surgery. The specifications and technique properties of Femto LDV Z8 are evaluated and compared with VisuMax
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