Sub-epithelial gas breakthrough during femtosecond laser flap creation for LASIK
Bibliographic record
Abstract
INTRODUCTION: The femtosecond laser produces photodisruption at the molecular level to generate plasma, displacing the surrounding tissue resulting in the formation of cavitation bubbles. We report a case of myopic LASIK in which a vertical gas break through the surface occurred during IntraLase femtosecond flap creation. CASE REPORT: A 30 year-old patient underwent bilateral Wavefront guided (WaveScan, Visx, USA) LASIK. The IntraLase (FS 60) was used to create a 100 microm flap. In the right eye, during flap creation in a raster mode, subepithelial gas breakthrough was noted in two focal areas. The surgeon was able to lift the flap without creating a buttonhole. The excimer ablation procedure was performed and the flap was repositioned. On the first postoperative day uncorrected visual acuity was 20/20 in both eyes. DISCUSSION: The incidence of flap-related complications associated with the use of motorized microkeratomes for creating corneal flap during LASIK is around 5%. For the femtosecond laser there have been previous reports of cavitation bubbles migrating to the anterior chamber resulting in poor tracking during subsequent excimer laser ablation. Vertical subepithelial gas breakthrough during femtosecond laser flap creation is rare and a PubMed search revealed no previous report of this complication. Vertical gas breakthrough occurs between the dissection plane and the subepithelial space resulting in escape of gas bubbles in to the subepithelial space. The cause is unknown but a thin flap or a focal break in the Bowman's membrane may contribute to this complication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".