Dissection Plane in Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique

Abstract

Dissection plane in DALK using the big-bubble technique can be within corneal stroma rather than exactly between stroma and DM. Various corneal pathologies as well as different techniques of dissection may have influence on this level.

Residual corneal stroma in big-bubble deep anterior lamellar keratoplasty: a histological study in eye-bank corneas

“…First, our findings corroborate those of Jafarinasab et al ,4 with residual stroma in both studies being of a similar range: 2.6–17.4 μm in our study and 6.4–25.8 μm in their study. Second, if a stromal-DM dissection plane does occur routinely in the white-margin big-bubble in vivo, we would have expected to see it at least once in 30 samples.…”

“…Recently, a study examined three keratoconic eyes that underwent big-bubble DALK and required intraoperative conversion to penetrating keratoplasty 4. Histological examination found that all three eyes had a residual stromal layer covering the excised DM.…”

Histopathology and Spectral Domain OCT Findings of Pneumatic-Assisted Dissection in DALK

“…In our study, there was no evidence of splitting of DM, which is also in agreement with the findings of Saw et al 14 in keratoconus patient corneas. However, even in the presence of a big bubble, there were obvious residual stromal fibrils attached to DM; both of these histopathologic findings are similar to those reported by Jafarinasab et al 18 It should be noted that our outcomes are mainly based on a laboratory model for DALK with limited clinical results. Therefore, further comparative clinical studies are needed to evaluate and corroborate our findings.…”

Rupture Pressure of the Posterior Lamella Obtained During Big-Bubble Deep Anterior Lamellar Keratoplasty

“…However, a recent study of 3 big-bubble DALK converted intraoperatively to PK showed residual stroma remaining on DM in the posterior lamella of all 3 cases, the stromal thickness ranging from 6.4 to 25.8 mm. 10 Another study of excised stroma in 4 cases of manual dissection DALK showed residual DM on the excised stroma in 2 cases with the authors concluding that intrastromal and intra-DM cleavage planes may be more likely than a plane between stroma and DM. 11 We are currently investigating this further in another study.…”