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Subconjunctival Hemorrhage and Bleeding
ETIOLOGY AND INCIDENCE OF SUBCONJUNCTIVAL HEMORRHAGE AND BLEEDING
Femtosecond LASIK
Subconjunctival hemorrhage can occur with IntraLase platforms (Abbott Medical Optics) when the syringe is applied too quickly or released too quickly during the suction application. It can also occur when multiple suction applications are needed due to suction loss. Bleeding from limbal vessels may also occur at the edge of the flap. It is seen most commonly in patients with limbal neovascularization and prior contact lens use. Limbal neovascularization as a result of rosacea, atopy, and meibomian gland dysfunction may also contribute to subconjunctival hemorrhage. Subconjunctival hemorrhage incidence is noted in 68.9% of eyes with the IntraLase (Abbott Medical Optics) platform but none with the VisuMax Femtosecond Laser (Zeiss).1 This is thought to be secondary to the variation in the docking mechanisms. For instance, suction is applied to the sclera with the IntraLase laser as compared to cornea with the VisuMax laser.1 Bleeding incidence is less than 1% with the femtosecond laser.
Figure 13-1. Photograph showing a large peripheral flap and peripheral vessels transected.
Microkeratome LASIK
Subconjunctival hemorrhage can occur with microkeratome LASIK from the suction ring. Micropannus formation is commonly seen with soft contact lens wear, and hemorrhage may occur if the microkeratome pass transects these vessels. This complication may be frequently encountered with larger flaps (9 to 9.5 mm) and larger treatment zones needed for hyperopia. With the microkeratome, subconjunctival hemorrhage incidence is between 50% and 70%.3 Bleeding incidence is less than 1% with the microkeratome.1,3
FEMTOSECOND LASIK COMPLICATIONS AND IMMEDIATE SOLUTIONS
Complication #1: Large Peripheral Flap
Video section: 0 minutes 5 seconds
Platform: WaveLight FS200 (Alcon Labs)
Flap diameter: 9.5 mm
Flap target depth: 110 microns (µm)
The initial surgery resulted in subconjunctival hemorrhage and bleeding in the interface (video 13; time: 0 minutes 5 seconds; Figures 13-1, 13-2, 13-3, and 13-4).
Some practical measures are as follows:
Figure 13-2. Photograph showing blood reaching the stromal bed.
Figure 13-3. Dry the stromal interface before applying the excimer laser.
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