Femtosecond Laser Versus Mechanical Microkeratome in Lasik

To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors. In this review, a comprehensive search of Medline, SCOPUS, Cochrane,TRIP database, supplemented by HTA and economic databases was performed. Wesearched for randomized controlled trials (RCTs) of Femtosecond laser which includedmechanical Microkeratome in other arm. The quality of the retrieved studies wasappraised by two independent reviewers and appropriate articles were finalized. A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews andRCTs were evaluated through CASP international worksheet. Eventually, 61 titleswere excluded, leaving 22 articles to be reviewed.Safety: There was no individual evidence to cover all safety components aboutFemtosecond laser, but in summary, this modality seems a safe method for cornealflap creation.Effectiveness: No statistically significant difference was shown in visual acuityand refractive errors. The important secondary end point of this review was diffuseLamellar keratitis in 17% of the Femtosecond group versus 5% in mechanicalMicrokeratome. Inflammation was low-grade and improved during the first 3 monthsof follow-up period with a low dose medication without corneal scarring. The twogroups was comparable in all clinical outcomes including Unorrected Visual Acuity(UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wavefront aberrometry, Schirmer test, and Tear Break up time (TBUT).Cost Analysis: Results showed that marginal cost incurred due to Femtosecondtechnology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). Itis clear that additional cost may be a small proportion of LASIK procedure total cost. Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiorityof Femtosecond laser in clinical outcomes. Although the efficacy and cost of thesystems is almost equal, traditional method still remains as the standard approach.