Vertical Gas Breakthrough During Femtosecond Laser Flap Creation for Laser In Situ Keratomileusis in an Eye with Previous Microkeratome Flap

  • Jorge L. AlióEmail author
  • Dominika Wróbel
  • Alessandro Abbouda


Using the femtosecond laser to create the corneal flap during laser in situ keratomileusis (LASIK) has many advantages in predictability and reliability over the microkeratome. However, each surgical procedure may have complications. One of them is vertical gas breakthrough as a result of escaping gas bubbles from the dissection plane into the subepithelial space. In this case, the cause would be related to a previous thin flap or a focal break in the Bowman’s layer. The refractive surgeon should be aware that this complication can be associated with epithelial down growth, corneal scar, and microstriae. A decrease of best corrected visual acuity (BCVA) may occur if the pupillary area is involved.


Femtosecond Laser Well Correct Visual Acuity Corneal Scar Corneal Topography Uncorrected Visual Acuity 
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Supplementary material

Video 24.1

A vertical bubble between the previous flap and the epithelium was clearly visible at the superior margin of the flap. The flap was gently lifted without creating a buttonhole. At the end, the standard excimer ablation procedure was performed (MP4 5937 kb)


  1. 1.
    Durrie DS, Kezirian GM (2005) Femtosecond laser versus mechanical keratome flaps in wavefront-guided laser in situ keratomileusis; prospective contralateral eye study. J Cataract Refract Surg 31(1):120–126CrossRefPubMedGoogle Scholar
  2. 2.
    Kezirian GM, Stonecipher KG (2004) Comparison of the IntraLase femtosecond laser and mechanical keratomes for laser in situ keratomileusis. J Cataract Refract Surg 30:804–811CrossRefPubMedGoogle Scholar
  3. 3.
    Srinivasan S, Herzig S (2007) Sub-epithelial gas breakthrough during femtosecond laser flap creation for LASIK. Br J Ophthalmol 91:1373PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Seider MI (2008) Epithelial breakthrough during IntraLase flap creation for laser in situ keratomileusis. J Cataract Refract Surg 34:859–863CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Jorge L. Alió
    • 1
    Email author
  • Dominika Wróbel
    • 2
    • 3
  • Alessandro Abbouda
    • 1
    • 4
    • 5
  1. 1.Department of Refractive SurgeryVissum Corporación OftalmológicaAlicanteSpain
  2. 2.Glaucoma Diagnostic and Microsurgery DepartmentMedical University of LublinLublinPoland
  3. 3.R&D DepartmentVissum CorporacionAlicanteSpain
  4. 4.Department of Ophthalmology-Policlinico Umberto I of RomeUniversity of Rome “Sapienza”RomaItaly
  5. 5.R&D DepartmentVissum Corporación OftalmológicaAlicanteSpain

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