PT  - JOURNAL ARTICLE
AU  - Marie-Claude Robert
AU  - Nour Khreim
AU  - Amit Todani
AU  - Samir A Melki
TI  - Anterior chamber gas bubble emergence pattern during femtosecond LASIK-flap creation
AID  - 10.1136/bjophthalmol-2014-306307
DP  - 2015 Sep 01
TA  - British Journal of Ophthalmology
PG  - 1201--1205
VI  - 99
IP  - 9
4099  - http://bjo.bmj.com/content/99/9/1201.short
4100  - http://bjo.bmj.com/content/99/9/1201.full
SO  - Br J Ophthalmol2015 Sep 01; 99
AB  - Aim To characterise the emergence pattern of cavitation bubbles into the anterior chamber (AC) following femtosecond laser-assisted in situ keratomileusis (LASIK)-flap creationMethods Retrospective review of patients undergoing femtosecond LASIK surgery at Boston Laser, a private refractive surgery practice in Boston, Massachusetts, between December 2008 and February 2014. Patient charts were reviewed to identify all cases with gas bubble migration into the AC. Surgical videos were examined and the location of bubble entry was recorded separately for right and left eyes.Results Five thousand one hundred and fifty-eight patients underwent femtosecond LASIK surgery. Air bubble migration into the AC, presumably via the Schlemm's canal and trabecular meshwork, occurred in 1% of cases. Patients with AC bubbles had an average age of 33±8 years with a measured LASIK flap thickness of 96±21 μm. The occurrence of gas bubbles impaired iris registration in 64% of cases. Gas bubbles appeared preferentially in the nasal or inferior quadrants for right (92% of cases) and left (100% of cases) eyes. This bubble emergence pattern is significantly different from that expected with a random distribution (p<0.0001) and did not seem associated with decentration of the femtosecond laser docking system.Conclusions The migration of gas bubbles into the AC is a rare occurrence during femtosecond laser flap creation. The preferential emergence of gas bubbles into the nasal and inferior quadrants of the AC may indicate a distinctive anatomy of the nasal Schlemm's canal.