Dataset Information

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

ABSTRACT:

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 microm 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%. 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. 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.

SUBMITTER: Srinivasan S

PROVIDER: S-EPMC2000995 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:AimTo compare postoperative clinical outcomes of high myopia after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).MethodsFrom March 2018 to July 2020, PubMed, MEDLINE, Embase, the Cochrane Library, and several Chinese databases were comprehensively searched. The studies meeting the criteria were selected and included; the data were extracted by 2 independent authors. The clinical outcome parameters were analyzed with RevMan 5.3.ResultsThis meta-analysis included twelve studies involving 766 patients (1400 eyes: 748 receiving SMILE and 652 receiving FS-LASIK). Pooled results revealed no significant differences in the following outcomes: the logarithm of the mean angle of resolution (logMAR) of postoperative uncorrected distance visual acuity (weighted mean difference (WMD) = -0.01, 95% confidence interval (CI): -0.02 to 0.00, I2 = 0%, P = 0.07 at 1 mo; WMD = -0.00, 95% CI: -0.01 to 0.01, I2 = 0%, P = 0.83 at 3 mo; WMD = -0.00, 95% CI: -0.01 to 0.00, I2 = 32%, P = 0.33 in the long term), and the postoperative mean refractive spherical equivalent (WMD = -0.03, 95% CI: -0.09 to 0.03, I2 = 13%, P = 0.30). However, the SMILE group had significantly better postoperative corrected distance visual acuity (CDVA) than the FS-LASIK group (WMD = -0.04, 95% CI, -0.05 to -0.02, I2 = 0%, P<0.00001). In the long term, postoperative total higher-order aberration (WMD = -0.09, 95% CI: -0.10 to -0.07, I2 = 7%, P<0.00001) and postoperative spherical aberration (WMD = -0.15, 95% CI: -0.19 to -0.11, I2 = 29%, P<0.00001) were lower in the SMILE group than in the FS-LASIK group; a significant difference was also found in postoperative coma (WMD = -0.05, 95% CI: -0.06 to -0.03, I2 = 30%, P<0.00001).ConclusionFor patients with high myopia, both SMILE and FS-LASIK are safe, efficacious and predictable. However, the SMILE group demonstrated advantages over the FS-LASIK group in terms of postoperative CDVA, while SMILE induced less aberration than FS-LASIK. It remains to be seen whether SMILE can provide better visual quality than FS-LASIK; further comparative studies focused on high myopia are necessary.