Sealability of ultrashort-pulse laser and manually generated full-thickness clear corneal incisions.

Purpose: To compare the sealability and geometry of full-thickness clear corneal incisions (CCIs) created manually or with an ultrashort-pulse laser.

Setting: Lensar, Inc., Orlando, Florida, USA.

Design: Experimental study.

Methods: Ex vivo human donor globes were randomly assigned to groups for the manual or laser-generated full-thickness CCIs. Standard 3-plane manual or laser incisions were made in 22 globes. Incision geometry was measured using an optical coherence tomographer. Sealability was assessed by inflating globes to physiologic intraocular pressure (IOP) and pressing a mechanical plunger into the globe to deform the globe and increase IOP until leakage was detected using the Seidel test. The test of sealability at lowered IOP was performed similarly; the anterior chamber was monitored for signs of ingress of a povidone-iodine 10% solution placed externally.

Results: The mean IOP elevation at which leakage occurred was higher for the laser than for manually generated full-thickness CCIs, indicating that the mean sealability was better for the laser. However, t tests showed that there was no statistically significant difference in the mean IOP elevation at which full-thickness incision leakage occurred between manual and laser full-thickness CCIs. Thus, the sealability of the manual and laser full-thickness CCIs were equivalent for the incision geometry tested. The laser full-thickness CCIs were statistically closer to target geometry and showed less variability than the manual full-thickness CCIs.

Conclusions: The sealability of laser and manual full-thickness CCIs were statistically equivalent. The laser full-thickness CCIs were more consistent in geometry and closer to the target incision geometry.