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Evaluation of four microkeratome models: quality and reproducibility of cut edge and cut surface as determined by scanning electron microscopy.

PURPOSE
To compare the quality and reproducibility of cuts produced by four automatic microkeratomes: Amadeus, Hansatome, Summit-Krumeich-Barraquer (SKBM), and Supratome. For the adjustable models (Amadeus and SKBM), the effects of oscillation frequency and blade feed rate were determined.


METHODS
Eight cuts (flap thickness 160 to 180 microm) were made with each microkeratome at each parameter setting and examined using a scanning electron microscope. Quality of the cut surface was scored for each flap according to four criteria, and results were averaged to give a maximum possible score of 64. Quality of the cut edges was scored from 1 (blurred indistinct edge) to 3 (sharp and clearly visible edge).


RESULTS
The four microkeratomes performed similarly on overall quality of the cut surface (range: 78% to 88% of theoretical maximum). The Hansatome scored highest (88%), followed by SKBM (86%; 1.0 mm/s blade feed and 7000 rpm oscillation), Amadeus (84%; 2.5 mm/s, 8000 rpm), Supratome (84%; 16.6 mm/s, 12,500 rpm), Amadeus (81%; 3.0 mm/s and 13,000 rpm), and SKBM (78%; 1.5 mm/s, 14,000 rpm). Performance differences were clearer for cut edge quality. The Amadeus produced cuts of the highest quality in 62.5% of cases (at both settings), compared with only 12.5% of cases with the Hansatome, 25% of cases with the Supratome and SKMB (1.0 mm/s, 7000 rpm), and in no cases with the SKBM at 1.5 mm/s and 14,000 rpm.


CONCLUSIONS
Overall, high frequency with low blade feed rate is desirable for reproducible sharp edges and cut area quality. However, at very high frequencies (e.g., 14,000 rpm with the SKBM) tissue is displaced, producing an uneven cut area. Oscillation/feed quotients of 2000 to 4000 (rpm/mm x s) are a good compromise. Sharp edges are believed to reduce the risk of comeal erosion, introduction of epithelial cells into the interfacial region, and scarring during wound healing.