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Air Bubbles in the Anterior Chamber
ETIOLOGY AND INCIDENCE OF AIR BUBBLES IN ANTERIOR CHAMBER
Anterior chamber (AC) gas bubbles are an occurrence specific to the femtosecond laser.1 It is hypothesized that gas bubbles enter through Schlemm’s canal.2 Some authors believe that the bubbles may be due to misdirected femtosecond laser pulses on the aqueous3; however, imaging with optical coherence tomography was performed and does not appear to support the theory that gas bubbles migrate into the AC through the trabecular meshwork.3 This is not consistent with our experience, where gas bubbles invariably enter the AC through the trabecular meshwork.
Studies comparing complication rates between the microkeratome and femtosecond-created flaps found that gas bubbles were present in the AC only in the femtosecond group (0.3%).4,5 Air bubbles appear more frequently in the inferonasal quadrant (> 50%).6 When air bubbles are present, they will interfere with pupil tracking in 50% of cases.6 Surgery can be completed later the same day in almost all cases without further complication by allowing the bubble(s) to resorb.
Figure 3-1. Initial surgery resulted in air bubbles in the AC (red arrow).
FEMTOSECOND LASIK COMPLICATIONS AND IMMEDIATE SOLUTIONS
Complication #1: Air Bubbles in Anterior Chamber Not Interfering With Excimer Laser Treatment
Video section: 2 minutes 9 seconds
Platform: IntraLase FS60 kilohertz (kHz) (Abbott Medical Optics)
Flap diameter: 9.3 mm
Flap target depth: 100 microns (µm)
The initial surgery resulted in air bubbles in the AC (video 2; time: 2 minutes 9 seconds; Figures 3-1, 3-2, 3-3, and 3-4).
Some practical measures are as follows:
Figure 3-2. VISX brand laser was used for the excimer procedure.
Figure 3-3. Dimming the light during the tracker registration was helpful to activate the tracker.
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