The next LASIK procedure?

Implications: This article describes the results of a "newer" refractive surgery technique known as sub-Bowman's keratomileusis or SBK.  SBK involves creating a corneal flap just below the epithelial layer of the cornea.  This flap is approximately 60-70 microns in thickness compared to a traditional LASIK flap which is approximately 120-160 microns.  

This prospective, randomized, contralateral eye study compared SBK and surface ablation (PRK) in 100 eyes of 50 patients.  The eyes that underwent SBK showed decreased postoperative dry eye, lower corneal sensitivity, similar higher-order aberrations and a higher rate of overall patient satisfaction.  In this study, flap creation was performed utilizing the Intralase femtosecond laser and the laser ablation was performed using an Alcon LadarVision excimer laser.

Analysis: Creating a thinner flap for corneal refractive surgery is not a new concept.  Indeed, several variations on this theme already exist - including epi-LASIK and other surface ablation techniques.  The rationale behind creating a thinner flap is primarily tissue preservation as LASIK utilizes an additional 120-160 microns of tissue. 

Alternatives to LASIK, such as PRK and epi-LASIK, have their own disadvantages including slowed post-operative recovery, risk of corneal scarring, and increased post-operative pain.

What is exciting about SBK or sub-Bowman's keratomileusis is that utilizing the Intralase femtosecond laser can create consistent thin flaps without the disadvantages of other surface ablation techniques.  As more surgeons look for tissue preserving techniques, consistency is critical. 

Look for more surgeons to begin using the Intralase for SBK.  And more SBK will probably mean more interest in Intralalse.