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Dr Teichmann is completely correct. The oscillating blade of the automated keratome is in a fixed position. The thickness of the excised cornea is determined by a depth plate that limits the protrusion of corneal tissue above the plane of the blade. If the plate is not properly seated, excessive corneal protrusion may allow a full-thickness incision. As the intraocular pressure is intentionally elevated by a suction ring, often to 65 mm Hg, the intraocular contents are immediately forced into such a perforating wound. In the case reported, the plate had not been fully seated in the automated keratome.The comments of Dr Teichmann remind us that accuracy and precision are as important when reporting the outcomes and complications of refractive surgery as when performing the surgery itself.
Sugar A. Outcome of Cornea, Iris, and Lens Perforation During Automated Lamellar Keratectomy-Reply. Arch Ophthalmol. 1997;115(6):823. doi:10.1001/archopht.1997.01100150825032