All-Laser vs. Microkeratome – What’s this Mean in the Lasik World?

By: Thomas Hunter

Lasik eye surgery is an amazing advancement in technology that has helped millions of people who want to obtain better vision. Though the concept behind Lasik surgery is essentially the same from surgeon to surgeon, the actual tools used can be slightly different. In fact, some surgeons prefer using the “all lasers” approach, while others use a microkeratome.

Recent Advances

Recently, developers have created the IntraLase system, which seems to improve the safety of the Lasik procedure. This is because IntraLase uses laser energy rather than the microkeratome in order to cut a thin flap in the eye’s cornea. The microkeratome, on the other hand, is a cutting tool that does not utilize this advanced technology.

Once the flap is but and lifted, energy from the excimer laser is used to reshape the cornea. This reshaping process helps to achieve a sharper focus. After the procedure is complete, the flap is put back in place and acts as a sort of natural “bandage” in the healing process.

Benefits of IntraLase

Complications during Lasik surgery are rare, but of those that do occur, most are the result of the oscillating blade of the microkeratomes. The metal blade of the tool can create uneven edges on the flap. This results in abnormal surfaces on the cornea, which can lead to vision defects like astigmatism.

The metal blades of microkeratomes also have been traced back to the formation or improper or incomplete flaps, which can lead to scars that distort vision. Many surgeons feel that this type of scarring is less likely to happen with the IntraLase system.

The IntraLase system creates flaps using laser energy by inserting an exact pattern of many small overlapping spaces. This pattern is created below the surface of the cornea. The laser of the IntraLase system is capable of operating at the very high speed of pulses every one quadrillionth of a second. This helps target the tissue and divide it a molecular level, rather than with heat or by impacting the surrounding tissue.

The IntraLase laser also makes it possible for individuals with thin corneas to undergo the procedure. Previously, those with thin corneas (of about 500 to 600 microns) were considered to be ineligible for the procedure because the microkeratomes cut about 100 to 200 microns. This caused too much of the cornea to be cut away. The IntraLase laser, on the other hand, can cut a flap as thin as 100 microns because it is more consistent and reliable.

Another advantage of the IntraLase laser is that it follows the cornea’s curvature. This creates a flap with more manageable vertical edges, rather than the thin edges created by microkeratomes. These thicker edges are less likely to tear. In addition, this reduces the likelihood of cells growing beneath the flap and pushing it up, which will create an irregular surface on the cornea. Partially formed flaps, or “buttonholed” flaps, are also less likely to occur with IntraLase.

The sterility of the IntraLase laser also decreases the chances of developing an eye infection.

Possible Complications of IntraLase

Although the IntraLase system is associated with far fewer Lasik complications than using microkeratomes, surgeons are noticing one possible complication of the system. Recently, some surgeons have reported that patients who undergo the “all lasers” Lasik procedure experience the postoperative complication of having an unusual sensitivity to light. According to reports this complication has occurred in 1-20% of IntraLase patients, although one surgeon only reported the 20% figure.

Fortunately, many surgeons also have reported that this postoperative complication is only temporary. In fact, they report that using steroid eye drops for a couple weeks seems to rectify the problem.

For those surgeons who prefer to use the IntraLase system, they argue that the side effects of IntraLase are only temporarily. The side effects of microkeratomes, on the other hand, are more serious and can be permanent.

Cost of IntraLase

Using the IntraLase system instead of microkeratomes may have an increase in overall safety, but it also increases the cost of the procedure. According to one report, using the “all lasers” approach adds an additional $300 per eye to the cost. Often, patients are given the choice between using a microkeratome or the IntraLase system. Some surgeons, on the other hand, exclusively use the IntraLase and automatically include it in their fee.


This information is not presented by a medical practitioner and is for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read. This statement has not been evaluated by the FDA and is not intended to “diagnose, treat, cure or prevent any disease".

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