For the last 4 years, the Amadeus Microkeratome (Advanced Medical Optics, Inc., Santa Ana, CA) has been my microkeratome of choice (Figure 1). My staff and I favor the device for its ease of use, the excellent quality of flaps it creates, and the minimal associated incidence of epithelial defects. Major advancements in the technology include the single-hand design and suction ring.

ERGONOMICS
This one-handed device does not require on-the-eye assembly, a benefit that shortens the learning curves of both surgeons and technicians. The fluted sides of the suction ring (available in 8.5- and 9.0-mm narrow and standard and 9.5-mm sizes) protect the eyelids, lashes, and drapes by keeping them separate from the operative field and

drive path of the microkeratome head. This feature improves the safety of the procedure. The Amadeus is the most efficient microkeratome I have used. The assembly process is identical for either eye, a feature that eliminates the need for adjustments during surgery and reduces the risk of intraoperative surgical complications.

CUSTOMIZATION
The customizability of the Amadeus Microkeratome allows both the beginning and advanced LASIK surgeon greater control. The physician may determine the head translation speed and blade oscillation rate, choose from several suction parameters, and vary the flap's size and hinge width. The device adapts to surgeons' varying techniques.

MAINTENANCE
I credit the microkeratome's pure titanium construction for the device's incredible durability. My clinic's unit has required only routine maintenance since its purchase, and its reliability from case to case has been extremely high.

FLAP THICKNESS
The Surepass disposable blades (Advanced Medical Optics, Inc.) provide up to 20,000 RPM of oscillation, and they are produced and inspected by hand in Switzerland. No generic blades are available for this unit. The Amadeus Microkeratome produces a nasally hinged flap that allows excellent visibility during the entire flap-creation process. The device can also produce a superiorly hinged flap, however, if appropriate.

In a recent study, Kerry Solomon, MD, and associates in Mount Pleasant, South Carolina, evaluated the accuracy of flap thicknesses and found that the Amadeus Microkeratome with the 140-µm head provided the most consistent and accurate flap-thickness measurements.1,2

SUMMARY
In my experience, the Amadeus Microkeratome produces high-quality flaps, and it remains my top choice owing to the device's incredible safety, simplicity, and reliability. After becoming accustomed to the patient protection the unit affords without on-the-eye assembly, I would find it difficult to return to using the older generation of microkeratomes.

Y. Ralph Chu, MD, is Medical Director of the Chu Laser Eye Institute in Edina, Minnesota, and is Adjunct Assistant Professor of Ophthalmology at the University of Minnesota. He is a consultant for Advanced Medical Optics, Inc. Dr. Chu may be reached at (952) 835-0965; yrchu@chulasereye.com.
1. Solomon KD. LASIK flap thickness. Paper presented at: The American Society of Cataract and Refractive Surgery Symposium on Cataract, IOL, and Refractive Surgery; June 2002; Philadelphia, PA.
2. Holzer MP, Sandoval HP, Kasper TJ, et al. Accuracy and reproducibility of LASIK flap thickness. Poster presented at: XX Congress of the European Society of Cataract and Refractive Surgeons; September 2002; Nice, France.