Rare intraoperative complication of femtosecond flap creation: Successful management of subepithelial vertical gas breakthrough

A 53-year-old man had flap creation with a femtosecond laser during laser in situ keratomileusis for the treatment of hyperopia. During flap creation, a subepithelial vertical gas breakthrough approximately 4.0 mm × 4.0 mm in diameter was noted under the small superficial scar in the inferior paracentral region of the left cornea. Because the flap cut was deep to the scar on anterior segment optical coherence tomography, the refractive laser ablation procedure was performed on the cornea on the same day. Subepithelial vertical gas breakthrough, a rare but serious intraoperative complication of femtosecond laser use, may be treated successfully.