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Novel method helps eliminate docking laser interface bubbles
The surgeon will also save time in the OR by eliminating the need for re-docking.
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Advances in laser technology continue to propel the laser surgical field forward and bestow improved quality of vision and quicker wound healing, thus improving our patients’ satisfaction with these laser-related ophthalmic procedures. One disturbing experience for the surgeon is the occurrence of interface bubbles while docking lasers. This results in downtime for the surgeon in the surgical suite.
In this column, Dr. Siepser describes a simple surgical technique that can solve the problem of interface bubbles while docking the laser on the ocular surface, thus saving valuable surgical time and making it a more enjoyable surgical experience for both the surgeon and the patient.
Thomas “TJ” John, MD
OSN Surgical Maneuvers Editor
Image: Siepser SB
Countless hours of repetitively repositioning interface lasers as a result of air bubbles in the laser path can now be easily avoided with this new method.
The controlled breaking of the hydrophobic, dry interface at the hydrostatic junction will frequently cause air to be captured in the interface. The placement of a drop of fluid on the descending dry interface breaks the surface tension centrally and causes the air present to move centrifugally. This centrally placed droplet creates a predictable fluid wave.
Our OR staff carefully places a drop of balanced salt solution on the lower surface on the upper dry patient interface. This is placed centrally and will adhere due to hydrostatic pressure. The adherent liquid forms a perfect hemisphere. When the interface is lowered, the central drop of fluid touches the liquid interface first, breaking the surface tension centrally. All air is forced toward the edge of the interface. As the interface lowers, air bubbles are eliminated and the procedure is not delayed by re-docking.
This simple and effective method will eliminate the hassle of interface bubbles, saving substantial OR time by eliminating the need for re-docking. The technique will avoid guessing about the position of a bubble, assure more consistent laser energy delivery and eliminate tiny, less visible bubbles. Using this routinely, our patient flow has improved. Interface bubbles are an oddity of the past. My staff refers to this technique as the “Sieps Drop,” as they are very used to the “Betadine Sieps Test.”
- For more information:
- Steven B. Siepser, MD, FACS, can be reached at Siepser Laser Eyecare, 860 E. Swedesford Road, Wayne, PA 19087; email: ssiepser@clear-sight.com.
- Edited by Thomas “TJ” John, MD, a clinical associate professor at Loyola University at Chicago and in private practice in Oak Brook, Tinley Park and Oak Lawn, Ill. He can be reached at tjcornea@gmail.com.
Disclosures: Siepser and John report no relevant financial disclosures.