Customizing the Amadeus® II microkeratome: Evaluation of cut quality with various settings using electron microscopy

Purpose. To evaluate the cut quality of keratectomy specimens created with the new Amadeus® II microkeratome (SIS, Ziemer Ophthalmic, Port, Switzerland) using scanning electron microscopy (SEM). Methods. Corneal cuts were performed in 24 freshly enucleated porcine eyes using the Amadeus® II microkeratome with combinations of cutting-head depth, oscillation rate, head-advance speed, and reuse of the blade. For the cutting trials, a 140-μm and 160-μm cutting head with three oscillation rates of 8,000, 10,000, and 13,000 rpm and two head-advance speed rates of 1.5 and 3.5 mm/s were chosen. In each setting, the blade was reused for a second time. All eyes were included, resulting in 4 groups with 6 eyes for each configuration. The surface and edge of the corneal cut was 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 for both cutting heads (140 μm/160 μm), especially when using the blade for a second time. At fixed head-advance speeds an increase in oscillation rates improved the cut quality for both cutting heads (140 μm/160 μm). This results in smoother surface characteristics and more regular cut edges, especially when using the blade for the first time. Conclusions. Using the Amadeus® II microkeratome for laser in situ keratomileusis procedures, the optimum oscillation rate, the optimum head-advance speed, and a single use of the blade will produce a very smooth and regular surface and cut edge for safe, comfortable, and improved customized refractive surgery.