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 Post subject: Gas breakthrough during femtosecond laser flap creation
PostPosted: Thu Sep 27, 2007 12:29 pm 
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Br J Ophthalmol. 2007 Oct;91(10):1373.

Sub-epithelial gas breakthrough during femtosecond laser flap creation for LASIK.

Srinivasan S, Herzig S.
Sathish Srinivasan, Herzig Eye Institute, Toronto and Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; sathish@tiscali.co.uk.

Introduction: The femtosecond laser produces photodisruption at the molecular level to generate plasma, displacing the surrounding tissue resulting in the formation of cavitation bubbles. We report a case of myopic LASIK in which a vertical gas break through the surface occurred during IntraLase femtosecond flap creation.

Case report: A 30 year-old patient underwent bilateral Wavefront guided (WaveScan, Visx, USA) LASIK. The IntraLase (FS 60) was used to create a 100 mum flap. In the right eye, during flap creation in a raster mode, subepithelial gas breakthrough was noted in two focal areas. The surgeon was able to lift the flap without creating a buttonhole. The excimer ablation procedure was performed and the flap was repositioned. On the first postoperative day uncorrected visual acuity was 20/20 in both eyes.

DISCUSSION: The incidence of flap-related complications associated with the use of motorized microkeratomes for creating corneal flap during LASIK is around 5%.1 2 For the femtosecond laser there have been previous reports of cavitation bubbles migrating to the anterior chamber resulting in poor tracking during subsequent excimer laser ablation.3 4 Vertical subepithelial gas breakthrough during femtosecond laser flap creation is rare and a PubMed search revealed no previous report of this complication. Vertical gas breakthrough occurs between the dissection plane and the subepithelial space resulting in escape of gas bubbles in to the subepithelial space. The cause is unknown but a thin flap or a focal break in the Bowman's membrane may contribute to this complication.

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PostPosted: Wed Oct 24, 2007 1:46 pm 
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JCRS
June 2007
Vol 33 Issue 6
page 1134-1135

Anthony N. Kuo, MD, Terry Kim, MD

Persistent anterior chamber gas bubbles during IntraLASIK

Quote:
In the right eye, bubbles were seen in the anterior chamber prior to photoablation (Figure 1). Automated tracking could not be engaged with the bubbles. There was no change after an hour. Because the treatment plan was straightforward, with minimal higher-order aberrations, manual tracking was continued to complete the −2.50 −0.36 ? 22 ablation. Three hours after the bubbles were initially observed, the patient returned home without resolution of the bubbles.


Quote:
The postulated mechanism for entry of these bubbles is via an intralamellar route to the trabecular meshwork, where they can then access the anterior chamber.1, 2 Large-diameter flaps require the IntraLase to treat close to the limbus, and this proximity could allow wayward bubbles to exit via the trabecular meshwork. In our patient, the eye with the 9.0 mm flap developed anterior chamber bubbles.

These bubbles interfere with the recognition of the pupil and iris by automated tracking systems and thus may complicate wavefront excimer laser treatments.

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"What concerns me is that if the person informing the patient is themselves poorly or inaccurately informed then how on earth can consent ever be truly informed?" Dr. Sarah Smith


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