International Journal of Keratoconus and Ectatic Corneal Diseases

Register      Login

VOLUME 7 , ISSUE 2 ( July-December, 2018 ) > List of Articles

Surgical Technique

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

Sandro Coscarelli, Leonardo Torquetti

Keywords : Deep anterior lamellar keratoplasty, Dua's layer, Type II big bubble

Citation Information : Coscarelli S, Torquetti L. Surgical Management of Type II Big Bubble in Deep Anterior Lamellar Keratoplasty. Int J Kerat Ect Cor Dis 2018; 7 (2):145-150.

DOI: 10.5005/jp-journals-10025-1172

License: CC BY-NC 4.0

Published Online: 01-08-2013

Copyright Statement:  Copyright © 2018; The Author(s).


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.

PDF Share
  1. Sarnicola V, Toro P, Sarnicola C, et al. Long-term graft survival in deep anterior lamellar keratoplasty. Cornea 2012;31(6):621- 626.
  2. Krumeich JH, Knulle A, Krumeich BM. Deep anterior lamellar (DALK) vs. penetrating keratoplasty (PKP): a clinical and statistical analysis. Klin Monbl Augenheilkd 2008;225(7):637- 648.
  3. Reinhart WJ, Musch DC, Jacobs DS, et al. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the American Academy of Ophthalmology. Ophthalmol 2011;118(1):209-218.
  4. Espandar L, Carlson AN. Lamellar keratoplasty: A literature review. J Ophthalmol 2013:894319.
  5. Anwar M, Teichmann KD. Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 2002;28(3):398-403.
  6. Jafarinasab MR, Rahmati-Kamel M, Kanavi MR, et al. Dissection plane in deep anterior lamellar keratoplasty using the big-bubble technique. Cornea 2010;29(4):388-391.
  7. Javadi MA, Mohammad-Rabei H, Feizi S, et al. Visual outcomes of successful versus failed big-bubble deep anterior lamellar keratoplasty for keratoconus. J Ophthalmic Vis Res 2016;11(1):32-36.
  8. Dua HS, Faraj LA, Said DG, et al. Human Corneal Anatomy Redefined. Ophthalmol 2013;120(9):1778-1785.
  9. Katamish D, Faraj S. Differentiating type 1 from type 2 big bubbles in deep anterior lamellar keratoplasty. Clinical Ophthalmol 2015:9:1155-1157.
  10. Coscarelli S, Torquetti L. Easy Bubble: Pachymetry-assisted Big-Bubble Deep Anterior Lamellar Keratoplasty. J Emmetrop 2012;3:153-156.
  11. Goweida MB. Intraoperative review of different bubble types formed during pneumodissection (big-bubble) deep anterior lamellar keratoplasty. Cornea 2015;34(6):621-624.
  12. Dua HS, Faraj LA SD. Dua's layer: its discovery, characteristics and clinical applications. Biomechanica y arquitetura corneal (corneal architecture and biomechanics). Ángeles del Buey Sayas MA, Cris Peris Martínez CP Elsevier 2014; Chapter 4 p 35-4747.
  13. Sarnicola E, Sarnicola C, Sabatino F, et al. Cannula DALK Versus Needle DALK for Keratoconus. Cornea 2016; 35(12):1508-1511.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.