‘Expanding bubble’ modification of ‘big-bubble’ technique for performing maximum-depth anterior lamellar keratoplasty

Abstract

Purpose To describe a new technique for performing maximum-depth anterior lamellar keratoplasty. Methods This was a case series study using a novel method. We introduce and describe a new sign (sunny-side up sign) that reveals the presence and extent of the air bubble at the Descemet membrane (DM)-stroma interface. We also report a novel technique to expand the bubble by injecting viscoelastic material into the bubble cavity and to excise the stromal tissues within the trephination area almost completely. The follow-up period ranged from 12 to 16 months. In all patients we recorded the best spectacle-corrected visual acuity, keratometry, and endothelial cell count preoperatively and postoperatively and the air bubble diameter using the sunny-side up sign. Results In eight of nine patients, a big bubble formed. The size of the air bubble ranged from 2 to 7 mm. All the bubbles were expanded to 8 mm and the bare DM throughout the trephination area was obtained in all cases. The postoperative mean keratometric readings were reduced compared with the preoperative mean keratometric readings. The BSCVA was increased postoperatively compared with the preoperative acuity. The difference between the preoperative and postoperative endothelial cell counts was not statistically significant. Conclusions The early outcomes in our series using the expanding bubble technique suggest that it is safe and easy in performing maximum-depth anterior lamellar keratoplasty.

Corneal Ectasia Preferred Practice Pattern®

“…5,128 The largebubble modification of the big-bubble technique utilizes a shallower trephination with a larger expansion of the bubble to the periphery. 132,133 The femtosecondassisted big-bubble technique utilizes a femtosecond laser program to trephine the cornea and then to create a big bubble to separate Descemet membrane, remove residual stroma, and place a femtosecond-laser trephined cornea. [134][135][136] Outcomes There are conflicting reports on the data comparing DALK and PK.…”

Microbubble technique in failed deep anterior lamellar keratoplasty: 2-year outcomes

“…Relatively simple and safe, the success rate of achieving BB ranges from 50% to 90% (3, 4). Should BB fail to separate Descemet membrane from the endothelium, the operation can transition to PK or the surgeon can attempt to expose Descemet membrane by means of manual layer-by-layer removal of stromal tissue by other techniques (5-9).…”

Manual Deep Anterior Lamellar Keratoplasty

“…The rationale of this technique was to create an air bubble at the DMstroma interface that was larger than the trephination wound so that total removal of the corneal stromal tissues could be accomplished with scissors to perform the TALK procedure. The "expanding-bubble modification of the big-bubble technique" (Daneshgar & Fallahtafti, 2011) is the method that I believe is useful for providing full exposure of the DM and performing TALK. The procedure is performed as follows: A partial-thickness trephination to a depth of about 60% to 80% of the corneal thickness is performed as described in the big-bubble technique .…”