Intraoperative Review of Different Bubble Types Formed During Pneumodissection (Big-Bubble) Deep Anterior Lamellar Keratoplasty

Goweida, Mohamed Bahgat

doi:10.1097/ico.0000000000000407

Cited by 55 publications

(31 citation statements)

References 16 publications

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“…15 In our study, postoperative complications are reported more frequently after PK compared to DALK and it is comparable to 31.8% vs. 4.5% in another study. 16 This may be because DALK is essentially an extraocular procedure so there are less chances of complications in DALK as compared to PK.…”

supporting

confidence: 68%

Comparison of Visual Outcomes of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty

Goel¹,

Agarwal²,

Chouhan³

et al. 2017

jemds

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supporting

confidence: 68%

Comparison of Visual Outcomes of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty

Goel¹,

Agarwal²,

Chouhan³

et al. 2017

jemds

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“…It is more prone to form in old patients and those with deep corneal scars, advanced keratoconus, and thin corneas. 11 In one study, eyes with the type 2 bubble showed a high frequency of conversion to PK (86%). 11 Because of this, it is imperative that the surgeon is able to recognize intraoperatively which BB has formed and better surgical strategies adopted to manage type 2 bubbles for successful DALK.…”

Section: Discussionmentioning

confidence: 97%

Surgical Management of Type II Big Bubble in Deep Anterior Lamellar Keratoplasty

Torquetti¹,

Coscarelli²

2018

International Journal of Keratoconus and Ectatic Corneal Diseases

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Purpose: To present some simple surgical maneuvers to manage a type 2 big bubble (BB) in deep anterior lamellar keratoplasty (DALK). Methods:Four DALK procedures with type 2 or mixed BB were performed. One was in the right eye of a 25-year-old female. The corrected distance visual acuity (CDVA) was 20/200 due to advanced keratoconus. The second case was in a 28-year old male with central-anterior stromal scarring and neovascularization due to infectious keratitis and CDVA <20/400. The third case was in a 20-year-old male with advanced keratoconus and CDVA <20/400. The fourth case was a 49-year-old female, with high irregular astigmatism due to radial keratotomy and her CDVA was 20/150. Results:At the last follow-up at 12 months, the first case of advanced keratoconus had a clear graft with CDVA = 20/50 and some Descemet's folds that were in the visual axis, corresponding to the are of type 2 BB that was not deflated intraoperatively. The second case achieved a CDVA = 20/40, without folds at the visual axis at 12 months of follow-up. In the third and fourth patients with mixed BB where DL was retained, the CDVA was 20/25 and 20/30, respectively. No intraoperative DM perforation or postoperative complications were noted.Conclusion: Type 2 BB in DALK can be properly managed in order to avoid perforation and to attain a good visual outcome.

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“…16,28,29 Our study instead chose to look at BB type based on size, with full BB describing a single, centrally located bubble of 7 mm in diameter or larger, partial BB describing a single bubble smaller than 7 mm in diameter or multiple smaller bubbles, and no BB describing the complete absence of any bubble. We did this because clinically, our distinction of full, partial, or no BB formation determines the next step of the DALK procedure.…”

Section: Discussionmentioning

confidence: 99%

Needle Depth and Big-Bubble Success in Deep Anterior Lamellar Keratoplasty

Pasricha

Shieh

Carrasco-Zevallos

et al. 2016

Cornea

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Purpose To examine big bubble (BB) formation success rates in deep anterior lamellar keratoplasty (DALK) at various corneal depths using real-time guidance from swept-source microscope-integrated optical coherence tomography (SS-MIOCT). Methods The DALK procedure was performed ex vivo with 34 human donor corneoscleral buttons on pressurized artificial anterior chambers using Anwar and Teichmann’s BB technique. We inserted a needle under controlled ex vivo conditions to corneal depths ranging from 40–90+% using real-time guidance from SS-MIOCT and injected air. BB success was then determined for each injection. Results The average needle depth for successful full BB formation was 79.9±3.0% compared to 66.9±2.6% for partial BB formation and 49.9±3.4% for no BB formation (P<.0001). Expressed as stroma below the needle tip, this corresponded to 123.9±20.0 µm for successful full BB formation compared to 233.7±23.8 µm for partial BB formation and 316.7±17.3 µm for no BB formation (P<.0001). All other variables tested (gender, race, age, endothelial cell density, air injected, needle angle, and central corneal thickness) did not significantly affect BB formation success rates. Conclusions BB formation in DALK is more successful if needle insertion and air injection occur at deeper corneal depth. However, 90+% corneal depth was not necessary in this ex vivo model of DALK. SS-MIOCT can be used to accurately guide the needle in real-time.

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Intraoperative Review of Different Bubble Types Formed During Pneumodissection (Big-Bubble) Deep Anterior Lamellar Keratoplasty

Abstract: The type 2 bubble is more likely to form in elderly patients and those with deep corneal scars and thin corneas. Because of the high rate of conversion to penetrating keratoplasty, better surgical strategies may be needed to manage type 2 bubbles.

Cited by 55 publications

References 16 publications

Comparison of Visual Outcomes of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty

Comparison of Visual Outcomes of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty

Surgical Management of Type II Big Bubble in Deep Anterior Lamellar Keratoplasty

Needle Depth and Big-Bubble Success in Deep Anterior Lamellar Keratoplasty

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