Refractive Surgical Problem

A 32-year-old man planned to have laser in situ keratomileusis (LASIK) in both eyes. The preoperative manifest refraction was 6.50 + 1.00 80 in the right eye and 6.25 + 1.00 90 in the left eye, yielding a visual acuity of 20/20 in both eyes. Topography was normal. Ultrasound pachymetry was 581 mm in the right eye and 574 mm in the left eye. The LASIK procedure was performed with a femtosecond laser, creating an 8.8 mm, 110 mm flap without incident in the right eye. In the left eye, however, a dense opaque bubble layer (OBL) appeared to interfere with the laser dissection. When a flap lift was attempted, the flap adhered to the underlying stromal bed. Therefore, the LASIK was aborted in the left eye. Postoperatively, the uncorrected distance visual acuity (UDVA) was 20/20 in the right eye. There was no change in refraction or topography in the left eye. Figure 1 shows a slitlamp photograph of the left eye. Would you advise this patient to have the left eye treated and if so, when? What procedure(s) would you consider for the patient? If you elect to perform LASIK in the left eye, what would the flap parameters be; would you choose a microkeratome or femtosecond laser to create the flap?