Comparing Elliptical Vs Circular Flaps For High Astigmatic Ablation In Lasik
Published 2026 - 44th Congress of the ESCRS
Reference: FP31.07 | Type: Free paper | DOI: 10.82333/4ren-bq90
Authors: Dr Hagay Hayat* 1 , Dr Fadi Garzozy 1 , Dr Shawn Sapir 1 , Tzahi Sela 2 , Gur Munzer 2 , Prof. Igor Kaiserman 3
1ophthalmology department,Barzilai University Medical Center,Ashkelon,Israel, 2ophthalmology department,Care-Vision Laser Center,Tel-Aviv,Israel, 3ophthalmology department,Barzilai University Medical Center,Ashkelon,Israel;ophthalmology department,Care-Vision Laser Center,Tel-Aviv,Israel;Faculty of health science ,Ben Gurion University of the Negev,Beer-Sheba,Israel
Purpose
To evaluate whether elliptical flaps are more suited for astigmatic ablation in eyes with high astigmatism undergoing Femto-LASIK
Setting
A retrospective, single-centered cross-sectional analytic study investigating ablation location within flap boundaries in high astigmatic myopic eyes undergoing LASIK with elliptical versus circular flaps. The comparison was conducted between two different refractive surgeons, with one surgeon routinely performing circular flaps of 9.0 mm diameter and the other routinely performing elliptical flaps measuring 9.2×8.5 mm, which were intentionally rotated to align with the astigmatic ablation axis
Methods
For each included case, archived surgical video recordings were reviewed, and the ablation location was analyzed using computerized image-processing software to identify flap margins and quantify the percentage of excimer ablation occurring within the flap boundaries.
Results
A total of 117 eyes of 59 patients were included: 60 eyes underwent elliptical flap LASIK, and 57 eyes circular flap LASIK. Mean age was 28.93 ± 7.9 years in the elliptical group and 27.33 ± 7.4 years in the circular group. Mean treatment ablation optical zone was 6.92 mm in the elliptical group and 6.5 mm in the circular group (p<0.01). Despite a larger treatment zone, the elliptical flap group had 98% of ablation within flap boundaries versus 96% in the circular group (p<0.01). Additionally, 11.6% of elliptical eyes had ≥5% of ablation outside flap boundaries, compared with 22.8% in the circular group. Final uncorrected visual acuity (UCVA) was 0.98 in the elliptical group versus 0.94 in the circular flap group (p<0.05).
Conclusions
In eyes with high astigmatism, elliptical LASIK flaps accommodate more accurately the astigmatic ablation within flap borders than circular flaps, with a lower incidence of ablation extending beyond the flap margins and better final UCVA