Microbubble incision as a new rescue technique for big-bubble deep anterior lamellar keratoplasty with failed bubble formation

Cornea. 2013 Feb;32(2):125-9. doi: 10.1097/ICO.0b013e31824a226f.

Abstract

Purpose: To describe a new surgical technique allowing dissection down to Descemet membrane in big-bubble deep anterior lamellar keratoplasty (DALK) with failed big-bubble formation (the "microbubble incision technique").

Methods: This is an interventional case series of 10 consecutive patients with keratoconus undergoing intended big-bubble DALK with failure to establish a normal big bubble. In all patients, repeated air injections into the stroma were performed, leaving a whitish colored stroma. Lamellar dissection as far down as possible was then performed within this white tissue. As soon as the anterior chamber was visible, a large remaining intrastromal air bubble was incised with a sharp 15-degree knife introduced perpendicular to the tissue to open up this predescemetic bubble. If deeper air bubbles were still visible, this approach was repeated. Using a blunt spatula, this new layer was then prepared and viscodissection performed.

Results: Using this novel approach, in 9 of the 10 patients, it was possible to dissect down to Descemet membrane. Macroperforation made conversion to penetrating keratoplasty necessary in 1 patient. Microperforations not necessitating conversion occurred in 2 patients. All 9 patients with "rescued" DALK had an uneventful postoperative course and had a mean visual acuity of 20/63 ± 20/125 (range, 20/500-20/50) and a mean endothelial cell count of 1672 ± 163 cells per square millimeter (range, 1493-1867 cells/mm) at 3 months.

Conclusions: Microbubble incision is a new rescue technique for big-bubble DALK patients without bubble formation allowing for a safer dissection down to Descemet membrane.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air
  • Cell Count
  • Corneal Stroma / surgery*
  • Descemet Membrane / surgery*
  • Descemet Stripping Endothelial Keratoplasty / methods*
  • Dissection / methods
  • Endotamponade / methods
  • Endothelium, Corneal / pathology
  • Female
  • Humans
  • Iris / surgery
  • Keratoconus / surgery*
  • Lasers, Solid-State / therapeutic use
  • Male
  • Middle Aged
  • Visual Acuity / physiology
  • Young Adult