Epi-LASIK using the Amadeus II microkeratome: evaluation of cut quality using light and electron microscopy.

Purpose: To investigate the cut quality and surface characteristics of the epithelial flap and underlying Bowman's membrane created by the Amadeus II (AMO) microkeratome on human corneas using light and electron microscopy.

Setting: Center for Refractive Therapy, Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany.

Methods: Using a 9.0 mm type II suction ring and settings, as recommended by the manufacturer, epithelial laser in situ keratomileusis (epi-LASIK) was performed in 2 fresh human eyes of 1 donor. Ocular pathology and previous ocular surgery were ruled out. Tissues for light microscopy were examined using hematoxylin-eosin and periodic acid-Schiff reaction staining. Further tissue samples were examined using scanning electron microscopy and transmission electron microscopy.

Results: Light microscopy showed a thoroughly separated epithelial sheet with no evident anatomical abnormalities. Stratification of the separated epithelium layer and cell shape was conserved. The cleavage plane was located at Bowman's membrane. Scanning electron microscopy showed a consistent transition from adherent epithelium to the denuded area. Bowman's layer showed a very smooth surface without remains of basal lamina. Transmission electron microscopy examination showed interruptions of the basement membrane at high magnification.

Conclusions: This in vitro study found a high cut quality using the epi-LASIK separator of the Amadeus II microkeratome. The resulting cleavage plane at Bowman's membrane was well suited for the subsequent laser ablation.