Evaluation of cut quality using the Amadeus microkeratome with different settings

PURPOSE: To evaluate the quality of keratectomy specimens created with the Amadeus microkeratome (AMO) using scanning electron microscopy (SEM). SETTING: Johannes Gutenberg-University Hospital, Department of Ophthalmology, Mainz, and the Department of Anatomy, Justus Liebig-University, Giessen, Germany. METHODS: Corneal cuts were performed in freshly enucleated pig eyes using the Amadeus microkeratome with 9 combinations of oscillation rate and head-advance speed. For the cutting trials, oscillation rates of 8000, 13,000, and 18,000 rpm and head-advance speeds of 1.0, 2.5, and 4.0 mm/s were chosen. Fifty-four eyes were included, resulting in 9 groups of 6 eyes for each configuration. The surfaces and edges of the flaps were examined using SEM. RESULTS: At fixed oscillation rates, an increase in head-advance speed led to lower quality cuts, higher surface roughness, and irregular cut edges. At fixed head-advance speeds, an increase in oscillation rates improved the cut quality, resulting in smoother surface characteristics. CONCLUSIONS: Smooth and regular surfaces and cut edges can be achieved by choosing high oscillation rates and low head-advance speeds. Microkeratomes that enable the user to adjust the oscillation rate and head-advance speed can be used to maximize surface smoothness and improve customized refractive surgery.