Flap Complications from Femtosecond Laser-assisted in<i>Situ</i>Keratomileusis

Tucker, Steven H.; Sood, Pallavi

doi:10.17925/usor.2019.12.1.21

Cited by 6 publications

(18 citation statements)

References 65 publications

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“…The suction loss occurs more likely when the suction cup is not perfectly applied on the eye, allowing the fluid to pass between the eye and the suction cup (39). Other predisposing factors for suction loss are: flat corneas, excessive tearing reflex, narrow palpebral aperture, bad positioning of the patient, poor compliance of the patient due to anxiety or inability to follow instructions (40)(41)(42). Suction loss can occur in any step of flap creation.…”

Section: Discussionmentioning

confidence: 99%

“…If the suction loss occurs either after the flap was fully created or during the creation of the side cut, the procedure can be resumed from the moment of interruption after proper re-docking (1,42). Cavitation gas bubbles produced by the femtosecond laser can lead to specific complications (1,42). OBL occurs when these bubbles expand and become trapped in the anterior stroma, at the interface plane (1,42).…”

Section: Discussionmentioning

confidence: 99%

“…Severe OBL presence can interfere with interface dissection (42) and can disturb eye tracking of the excimer laser (46). In addition to the OBL, the cavitation gas bubbles can produce other complications: vertical gas breakthrough with buttonhole formation or presence of the bubbles in the anterior chamber (42).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…A vertical channel, a so-called buttonhole, is then created, and complications such as epithelial ingrowth and scarring can affect the outcome of the procedure. 9,64 Reduction of the opaque bubble layer when using a vortex beam can, therefore, greatly improve the dissection process.…”

Section: Potential Improvements Of Refractive Surgery By Focus Shapingmentioning

confidence: 99%

“…Femtosecond laser-assisted in situ keratomileusis (LASIK) was introduced in the 1990s [1][2][3][4][5] and is a wellestablished method to correct refractive errors such as hyperopia, myopia, or astigmatism in the human eye; more than 18 million operations have been reported worldwide. [6][7][8][9] A decade ago, small incision lenticule extraction (SMILE) was introduced. 10 Here, a small lenticule is dissected within the corneal stroma and removed through a small side cut to correct the refractive error in one step using only the infrared (IR) femtosecond (fs) laser system.…”

Section: Introductionmentioning

confidence: 99%

Optical Vortex Beam for Gentle and Ultraprecise Intrastromal Corneal Dissection in Refractive Surgery

Freidank

Vogel

Linz

2020

Trans. Vis. Sci. Tech.

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We introduce a novel focus shaping concept for intrastromal corneal dissection that facilitates cleavage along corneal lamellae, and we analyze laser-tissue interactions governing cutting effectiveness and mechanical side effects. Methods: Focus shaping was achieved by a spiral phase plate that converts an incident Gaussian beam into a Laguerre-Gaussian beam with a helical phase. Such vortex beams have zero intensity at their center, are propagation invariant, and possess a ring focus equal in length to the Gaussian focus but with a larger diameter. Cutting precision and the required absorbed energy for flap dissection were compared for Gaussian and vortex beams on ex vivo porcine corneal specimens at pulse durations between 480 fs and 9 ps. Cutting quality and bubble formation were characterized by scanning electron microscopy and macro photography. Results: With the vortex beam, the cuts were much smoother. Bubble formation was markedly reduced because cutting can be performed close to the bubble threshold, whereas with the Gaussian beam energies well above threshold are needed. Although the incident energy at the flap dissection threshold was slightly larger for the vortex beam, the absorbed energy was much smaller and contributed more effectively to cutting. This reduced plasma-induced pressure more than sevenfold. Conclusions: The vortex beam approach for corneal dissection is a simple, versatile, and cost-effective way of improving the precision of refractive surgery while reducing bubble formation and pressure-related mechanical side effects. Translational Relevance: Phase plates for propagation invariant vortex beams are easily implemented in the beam path of next-generation clinical devices.

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Quantitative assessment of corneal elasticity distribution after FS‐LASIK using optical coherence elastography

Han,

Zhang,

Shi

et al. 2024

Journal of Biophotonics

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Quantifying corneal elasticity after femtosecond laser‐assisted in situ keratomileusis (FS‐LASIK) procedure plays an important role in improving surgical safety and quality, since some latent complications may occur ascribing to changes in postoperative corneal biomechanics. Nevertheless, it is suggested that current research has been severely constrained due to the lack of an accurate quantification method to obtain postoperative corneal elasticity distribution. In this paper, an acoustic radiation force optical coherence elastography system combined with the improved phase velocity algorithm was utilized to realize elasticity distribution images of the in vivo rabbit cornea after FS‐LASIK under various intraocular pressure levels. As a result, elasticity variations within and between the regions of interest could be identified precisely. This is the first time that elasticity imaging of in vivo cornea after FS‐LASIK surgery was demonstrated, and the results suggested that this technology may hold promise in further exploring corneal biomechanical properties after refractive surgery.

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Flap Complications from Femtosecond Laser-assisted inSituKeratomileusis

Cited by 6 publications

References 65 publications

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

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

Optical Vortex Beam for Gentle and Ultraprecise Intrastromal Corneal Dissection in Refractive Surgery

Quantitative assessment of corneal elasticity distribution after FS‐LASIK using optical coherence elastography

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