Opaque Bubble Layer Risk Factors in Femtosecond Laser-assisted LASIK

Courtin, Romain; Saad, Alain; Guilbert, Emmanuel; Grise-Dulac, Alice; Gatinel, Damien

doi:10.3928/1081597x-20150820-06

Cited by 33 publications

(21 citation statements)

References 18 publications

(25 reference statements)

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“…8,21 Kunert et al 9 demonstrated a decrease in the surface regularity index in femtosecond lenticule extraction accompanying an increase in pulse energy (150, 180, and 195 nJ), which also supported this conclusion. Moreover, the temporary accumulation of gas bubbles in the intrastromal interface creates transient opacity, or opaque bubble layer, which sometimes diffuses into the corneal stroma, subconjunctival space, and anterior chamber, 4,22 and further interferes with the subsequent procedures in SMILE, such as femtosecond laser photodisruption pulses and lenticule separation.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The energy needed to cause this reaction has been the focus of significant study. [3][4][5][6] The functional parameters of femtosecond lasers, such as the repetition rate of the laser system, energy, and spot-track-distance, significantly affect the interaction of the laser with the corneal tissue. De Medeiros et al 7 reported that femtosecond laser energy level had an effect on corneal stromal cell death and inflammation in a rabbit model.…”

Section: O R I G I N a L A R T I C L Ementioning

confidence: 99%

See 1 more Smart Citation

Energy Setting and Visual Outcomes in SMILE: A Retrospective Cohort Study

Li¹,

Schallhorn²,

Ma³

et al. 2018

J Refract Surg

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Section: Discussionmentioning

confidence: 99%

Section: O R I G I N a L A R T I C L Ementioning

confidence: 99%

Energy Setting and Visual Outcomes in SMILE: A Retrospective Cohort Study

Li¹,

Schallhorn²,

Ma³

et al. 2018

J Refract Surg

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“…OBL occurs when these bubbles expand and become trapped in the anterior stroma, at the interface plane ( 1 , 42 ). The incidence of OBL ranges up to 48% ( 42 , 43 ), its formation being influenced by flap diameter under 8 mm ( 44 ), thick corneas ( 43 , 45 ), high hysteresis ( 43 , 45 ) and laser settings such as: spot spacing, pocket size and energy level ( 42 ). Severe OBL presence can interfere with interface dissection ( 42 ) and can disturb eye tracking of the excimer laser ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative flap‑related complications in FemtoLASIK surgeries performed with Visumax� femtosecond laser: A ten‑year Romanian experience

et al. 2020

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Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax ® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax ® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation.

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“…Complications limited to femtosecond laser use are epithelial gas breakthrough [18] and opaque bubble layer (OBL) formation [1,59]. A vertical gas breakthrough occurs between the dissection plane and the subepithelial space, resulting in an escape of gas bubbles into the subepithelial space [60].…”

Section: Risk Of Intraoperative Complications Associated With Flap Creationmentioning

confidence: 99%

Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis

Kanclerz

Khoramnia

2021

Diagnostics

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Introduction: A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (LASIK) and LASIK using mechanical microkeratomes (MMKs). This study compares the flap thickness and risk of complications related to flap creation using femtosecond lasers and MMKs. Methods: PubMed and the Web of Science are used to search the medical literature. An extensive search is performed to identify the flap thickness and complications of LASIK as reported up to Jul 15, 2021. The following keywords are used in various combinations: Corneal flap, femtosecond laser, laser in situ keratomileusis, laser-assisted in situ keratomileusis, LASIK, mechanical microkeratome. Results: After removing duplicates and irrelevant studies, 122 articles were included for review. Pooled differences for intended vs. postoperative flap thickness using MMKs and femtosecond laser were −4.07 μm (95% CI: −19.55, 3.24 μm) in studies on the MMK and 5.43 μm (95% CI: 2.30, 7.84 μm; p < 0.001), respectively. After removing the studies evaluating outcomes of the old generation Hansatome MMKs (which had a significantly greater variation of flap thickness), the pooled difference for newer MMKs was 4.97 μm (95% CI: 0.35, 9.58 μm; p < 0.001), but the results still favored the femtosecond laser. Uncommon and mild complications unique for the femtosecond LASIK are epithelial gas breakthrough, opaque bubble layer, transient light sensitivity syndrome, and rainbow glare. A single study reported a very low, but stastically different risk of postoperative flap slippage (0.033% for MMK LASIK, and 0.003% for femtosecond LASIK, respectively). Conclusion: In both manual microkeratome and femtosecond LASIK, intra- and postoperative complications were uncommon. The evidence of the superiority of one technique in terms of complications over another cannot be indisputably stated.

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Opaque Bubble Layer Risk Factors in Femtosecond Laser-assisted LASIK

Abstract: This study confirms the already known OBL risk factors with a larger cohort and suggests for the first time that an elevated corneal hysteresis is an independent predictive risk for OBL occurrence.

Cited by 33 publications

References 18 publications

Energy Setting and Visual Outcomes in SMILE: A Retrospective Cohort Study

Energy Setting and Visual Outcomes in SMILE: A Retrospective Cohort Study

Intraoperative flap‑related complications in FemtoLASIK surgeries performed with Visumax� femtosecond laser: A ten‑year Romanian experience

Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis

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