Microkeratome Update
Several units have undergone performance-enhancing changes.
BY LOU KOURY, CONTRIBUTING EDITOR

The Amadeus II.

Focused on the goals of improving predictability and fostering a worry-free LASIK procedure, several manufacturers have redesigned or added new features to their microkeratomes. Ease of use and surgeon flexibility also have been enhanced. One new model features voice confirmation that it is safe for the surgeon to begin the procedure. Another is fully automated, yet disposable, decreasing the risk of contamination as well as patient turnover time. Others allow options for hinge placement or full visualization of the flap as it's being made.

Below is a description of the features of the latest microkeratomes.

Amadeus II. Advanced Medical Optics will launch the Amadeus II microkeratome at this year's American Academy of Ophthalmology meeting in New Orleans. The new microkeratome optimizes wavefront-driven ablation and increases safety, according to the company.

The instrument is interactive, including voice confirmation safety features. It allows full customization of all flap-creation parameters, and it tests all functional parameters before the surgeon creates the flap.

This titanium microkeratome has built-in assembly guides so it cannot be put together incorrectly. The unit also allows for altitude adjustment in order to provide maximum suction performance. The handpiece and power cord are smaller and lighter than in the previous version of the Amadeus.

Suction rings are available in 8.5 mm (standard and narrow), 9.0 mm (standard, narrow and Asian) and 9.5 mm (standard and narrow). Later this year, an 8.5-mm Asian, 9.5-mm Asian and 10.0-mm standard and narrow suction rings will be available.

The head sizes are 140 mm and 160 mm, and the oscillation speed ranges from 4,000 rotations per minute to 20,000 rotations per minute. The Amadeus II includes a 12-month warranty and it provides surgical data printouts.

For more information, call (714) 247-8200.

The Zyoptix XP.

Zyoptix XP. Bausch & Lomb's next-generation microkeratome is the Zyoptix XP. The unit provides surgeons with the option of creating a hinge at either a superior or nasal location. According to the company, another benefit of the new unit is that surgeons are able to move more efficiently from the left to right eye during bilateral procedures.

The company has enhanced the blade design and has reduced variability in flap thickness, addressing a key surgeon concern. In trial experience, surgeons reported smooth stromal beds and clean, even flap edges.

The microkeratome's design makes it surgeon-friendly, offering flexibility and ease of use in the operating room. One unique feature is the sterilizable motor sleeve, which reduces the potential for contamination. The Zyoptix XP is easy to have serviced. All the parts are interchangeable, so surgeons can order replacement or additional parts while keeping the system. This can reduce downtime and costs associated with servicing.

The microkeratome is compatible with the existing Hansatome power console to facilitate upgrade. The blades for the new microkeratome, however, are not interchangeable.

For more information, call (800) 338-2020.

The One Use-Plus.

One Use-Plus. Moria's latest development in microkeratomes is the automated disposable One Use-Plus. It features a new sterile suction ring, head-blade assembly and vacuum tubing for each patient. It will be introduced commercially this fall.

The microkeratome is fully automated with nasal hinging. This design creates consistent, predictable flaps, the company says. There is one motor for advancement and a separate motor for blade oscillation. Surgeons have the option of using the unit pre-assembled for one-handed operation.

The hinge size is fully adjustable with the option of a variety of stops. The One Use-Plus can also accommodate tighter orbits. According to reports of clinical practice results, the shape of the flap, quality of the flap edge, quality of stroma, gutter, and interface immediately after surgery are excellent. The company says the high-precision cast molding used to create the unit ensures that results are consistent, and that the system handles equivalent to traditional reusable systems.

The pre-assembled single-use microkeratome also allows faster patient turnover. There is no maintenance or sterilization required, and because it is disposable, there is little risk of contamination and subsequent infection. It also eliminates the risks of damaged heads and rings and blade handling.

This will also be the future platform for the Epi-K, Moria's epithelial separator for Epi-LASIK.

For more information, call (800) 441-1314.

BD K-4000.

BD K-4000. The Becton Dickinson K-4000 microkeratome features self-diagnostic and self-testing features on the unit. It uses a pre-assembled Beaver blade, which is sterile and enclosed in a nonmetallic safety blade holder.

The unit is battery operated, and the motor stops if there is a loss of suction. Further enhancing the safety of the microkeratome, the blade does not oscillate in reverse; there is an audible sound if the blade fails; and the microkeratome automatically stops if the translation is too fast or too slow. The entire flap procedure can be seen throughout the cut.

The blade on the unit oscillates at 12,000 ±500 rotations per minute with a translation speed of 4.4 mm/sec. The K-4000 employs suction ring sizes of 8.5 mm, 9 mm, 9.5 mm, 10 mm and creates a nasal hinge. The average hinge length is 5 mm; the flap diameter ranges from 8 mm to 11 mm; and heads are available in 130 µm, 160 µm or 180 µm.

Two-piece assembly is required. The microkeratome comes with a dual vacuum pump.

According to the company, the microkeratome features a backlit "smart" LCD display with an easy-to-use setup menu, comprehensive error messages, automated self-diagnostic testing, monitored blade oscillation, handpiece detection and a vacuum level measurement in either kPascals or inHg.

The console has easy-to-clean membrane control buttons and a reverse motor button. The titanium-constructed handpiece is ergonomically designed. Dual motors control operation; they automatically cease oscillation and retract the head upon completion of the procedure.

For more information, call (800) 237-2174.

The MK-2000.

MK-2000.  Nidek's MK-2000 microkeratome is easy to use, with virtually no learning curve, according to the company. The fact that it's a one-handed unit also adds to its ease of use.

The MK-2000's safety features include that it has no external gears. The surgeon can visualize the flap throughout the cut. In addition, no assembly is required on the eye. The company says the standard deviation of the flap thickness is very small, so flap depth is consistent.

The vacuum system eliminates excessive pressure by using dual suction. An internal function monitors vacuum levels and emits an audible sound until adequate suction is achieved and maintained.

The unit is automatic with an advance rate of 2 mm/sec and an oscillation rate of 9,000 rpm. It is ergonomically designed for the patient and surgeon. Available flap diameters are 8.5 mm, 9 mm, 9.5 mm and 10.5 mm with a blade angle of 25°. The low-profile suction ring accommodates all eye and brow types. The flap depths are available in 130 µm, 160 µm and 180 µm. Variable flap orientations are possible. While the standard hinge is nasal, others are possible.

According to surgeon experience, the microkeratome's head has a finely polished leading edge, which is gentle. The unit has a metal handpiece and operates on 115 V AC and 230 V AC.

For more information, call (510) 226-5700.