title: Management of bilateral gas-bubble breakthrough during femtosecond LASIK in the presence of anterior basement membrane dystrophy.
abstract: We describe the case of a 50-year-old woman with anterior basement membrane dystrophy and dry eyes who had femtosecond laser in situ keratomileusis (LASIK) with gas-bubble breakthrough during flap creation in both eyes. The gas-bubble breakthrough appeared beneath the applanation interface in advance of the leading laser edge in the right eye and behind the advancing laser edge in the left eye. The surgery was aborted and 5 days later, photorefractive keratectomy with mitomycin-C was performed in the right eye and LASIK in the left eye. When a gas-bubble breakthrough extends in front of the advancing laser edge of the flap, the surgery should be aborted; surface ablation can be performed as a second-stage procedure. However, if the breakthrough occurs behind the advancing laser edge, the flap can be carefully lifted and the LASIK completed.
  
  
  BACKGROUND
  Dr. Krueger is a consultant to Alcon Laboratories, Inc. Dr. Ribeiro has no financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, Ohio, USA.
authors.forename: Giovana Castilho
authors.initials: GC
authors.lastname: Ribeiro
authors.affiliation: From the Cleveland Clinic Foundation, Cole Eye Institute, Cleveland, Ohio, USA. Electronic address: krueger@ccf.org.
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Krueger
mesh_terms: D000477:Alkylating Agents / Q000008:administration & dosage; D001485:Basement Membrane / Q000473:pathology*; D003317:Corneal Dystrophies, Hereditary / Q000150:complications*; D015352:Dry Eye Syndromes / Q000150:complications; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D054018:Lasers, Excimer; D045423:Microbubbles; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D018903:Photorefractive Keratectomy; D012086:Reoperation; D013524:Surgical Flaps; D014792:Visual Acuity
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin