Dear peter,

Check this out:

Ophthalmic Surg Lasers Imaging. 2010 Jul-Aug;41(4):482-4. Management of anterior chamber gas bubbles during IntraLASIK.

Srinivasan S, Herzig S.

email:  [email protected]

Abstract

The femtosecond laser is gaining popularity as a safe and effective alternative to the microkeratome for creating corneal flaps during LASIK. Rarely, gas bubble formation in the anterior chamber during laser flap creation can interfere with the eye tracking and iris registration software during the subsequent excimer laser ablation. Surgical steps to ensure successful eye tracking and iris registration in such cases are described in this report.

Further references:

Corneal endothelial cell density after myopic intra-LASIK and the effect of AC gas bubbles on the corneal endothelium.  Tomita M, Watabe M, Waring GO 4th, Durrie DS.  Eur J Ophthalmol. 2011 Jul-Aug;21(4):363-7.

Visante anterior segment OCT in a patient with gas bubbles in the anterior chamber after femtosecond laser corneal flap formation.  Utine CA, Altunsoy M, Basar D.  Int Ophthalmol. 2010 Feb;30(1):81-4.

Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK.  Srinivasan S, Rootman DS.  J Refract Surg. 2007 Oct;23(8):828-30.

Sub-epithelial gas breakthrough during femtosecond laser flap creation for LASIK.  Srinivasan S, Herzig S.  Br J Ophthalmol. 2007 Oct;91(10):1373.

Anterior chamber gas bubbles after corneal flap creation with a femtosecond laser.  Lifshitz T, Levy J, Klemperer I, Levinger S.  J Cataract Refract Surg. 2005 Nov;31(11):2227-9.

Do not lift flap. Apply 5% betadine, topical anesthetic and bandage conact lens. Have patient sit upright until bubbles dissipate. Small bubbles are hard to see at slit lamp. You can periodically have patient lay of table to bring the bubbles to the apex. You dont have to redrape. You can also test iris reistration with BCL in place simply by parting lids with fingers without full lash drape and speculum.