Essential opaque bubble layer elimination with novel LASIK flap settings in the FS200 Femtosecond Laser

A John Kanellopoulos,1,2 George Asimellis1 1Laservision.gr Eye Institute, Athens, Greece; 2New York University School of Medicine, New York, NY, USA Background: The purpose of this study is to evaluate the extent and incidence of opaque bubble layer (OBL) using laser-assisted in situ keratomileusis (LASIK) flaps created with the Alcon/WaveLight FS200 femtosecond laser as a result of a recent change in flap programming parameters aiming to reduce further the incidence and extent of OBL. Methods: Intraoperative digital images of flaps from 36 consecutive patients (72 eyes) subjected to bilateral femtosecond-assisted LASIK were analyzed using a proprietary computerized technique. The incidence and extent of OBL was measured and reported as a percentage of the entire flap area. Flap creation was performed with a 1.7 mm wide canal, implemented as an updated design intended to reduce the extent of OBL (group A). The same OBL parameters were investigated and compared in an age-matched and procedure-matched patients in whom the previous standard setting of a 1.3 mm wide canal was implemented (group B). Results: In group A, the average extent of OBL was 3.69% of the flap area (range 0%–11.34%). In group B, the respective values were 6.06% (range 0%–20.24%). We found the difference to be statistically significant (one-tailed P = 0.00452). Conclusion: This study suggests that there is a significant reduction in the incidence and extent of OBL when novel LASIK flap ventilation canal parameters of width and spot line separation are used. Keywords: femtosecond laser flap, bladeless laser-assisted in situ keratomileusis, opaque bubble layer, Alcon/WaveLight FS200, spot line separation