PMC7678819_01
View of the patient interface. The vacuum-level gauge is within normal limits (yellow arrow).
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The vacuum-level gauge was within normal limits (Figure 1), and an image obtained using built-in anterior segment optical coherence tomography showed no abnormality.
A small bubble is seen appearing at 3'o clock in view of the patient interface (yellow arrow), when laser irradiation began.
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Soon after the operator started firing the laser, it was found that a small bubble appeared at 3 o'clock and disappeared (Figure 2).
During lens fragmentation, the bubble is still observed (yellow arrow).
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In the second half of the lens fragmentation process, the small bubble reappeared in the same area immediately after laser beam emission started (Figure 3).
The bubble slowly becomes bigger. Wrinkles in the conjunctiva (yellow arrow) and a small eye tilt are also observed. The vacuum-level gauge is still within normal limits (blue arrow).
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During that time, wrinkles in the conjunctiva and a small tilt of the eye were also observed, while the vacuum-level gauge was still within normal limits (Figure 4).
Misplacement of the laser beam in the corneal layers immediately after the suction break. The device is still emitting the laser beam (yellow arrow).
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Finally, the PI lost adhesion to the sclera (ie, suction break occurred); however, due to the high repetition rate of the laser system, a fraction of a second after the suction break was sufficient for the laser beam to slip onto the corneal layers (Figure 5).
The automatic laser-emission-stop system is activated (yellow arrow).
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Although the operator kept the foot pedal pressed even after the PI was detached from the eye, an automatic laser emission-stop system was activated (Figure 6).
Intraoperative view of the grid-pattern laser beam trace in the corneal layers (yellow circle).
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During removal of the fragmented lens with the laser, a grid-pattern laser beam trace was observed between 2 o'clock and 4 o'clock, between the corneal apex and corneal limbus (Figure 7).
Postoperative slit-lamp image of the grid-pattern laser beam trace 1 year after surgery (yellow circle).
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However, the grid-pattern laser beam trace was still observed in the cornea (Figure 8).