Abstract
Purpose. To report the 12-month follow-up after big-bubble deep anterior lamellar keratoplasty (DALK) assisted by femtosecond laser that we have called IntraBubble. Methods. A 60 kHz IntraLase femtosecond laser (Abbott Medical Optics) firstly created a 30° angled intrastromal channel to insert the air injection cannula, 50 μ above the thinnest corneal site measured by Sirius Scheimpflug camera (CSO, Firenze, Italy), then performed a full lamellar cut 100 μ above the thinnest corneal point, and from the same corneal depth, created a mushroom incision. The lamella was removed, and the smooth cannula of Fogla was inserted into the stromal channel and air was injected to achieve a big bubble. The follow up is 12 months, and sutures were removed by the 10th postoperative month in all patients. Best Corrected Visual Acuity (BCVA), spherical equivalent and, by Sirius Scheimpflug camera (CSO, Firenze, Italy) keratometric astigmatism were evaluated. Results. All procedures were completed as DALK except 2 converted to PK because an inadvertent intraoperative macroperforation occurred. Mean postoperative BCVA was 0.8, mean spherical equivalent was -3.5 ± 1.7 D, and mean keratometric astigmatism was 4.8 ± 3.1 D. Conclusion. The femtosecond laser could standardize the big-bubble technique in DALK, reducing the risk of intraoperative complications and allowing good refractive outcomes.
Highlights
The femtosecond solid-state laser [1] was successfully used in several corneal surgical procedures
Over time different surgical approaches have been proposed for Deep Anterior Lamellar Keratoplasty (DALK) [5,6,7,8,9], but the the big-bubble technique introduced by Anwar and Teichmann [10] in which air is injected into the deep stroma in an attempt to achieve a large air bubble between the Descemet’s membrane and the stroma to facilitate preDescemet’s plane dissection, probably at the moment results as the more common
We proposed a variant of the big-bubble technique in DALK assisted by femtosecond laser which we have called IntraBubble [11] in whom the laser allows a pre-Descemet’s plane lamellar dissection to a predefined corneal depth and the creation of a channel in the posterior stroma of the recipient, 50 μ above the corneal thinnest point, into which a smooth cannula for air injection can be introduced
Summary
The femtosecond solid-state laser [1] was successfully used in several corneal surgical procedures. Over time different surgical approaches have been proposed for Deep Anterior Lamellar Keratoplasty (DALK) [5,6,7,8,9], but the the big-bubble technique introduced by Anwar and Teichmann [10] in which air is injected into the deep stroma in an attempt to achieve a large air bubble between the Descemet’s membrane and the stroma to facilitate preDescemet’s plane dissection, probably at the moment results as the more common. We proposed a variant of the big-bubble technique in DALK assisted by femtosecond laser which we have called IntraBubble [11] in whom the laser allows a pre-Descemet’s plane lamellar dissection to a predefined corneal depth and the creation of a channel in the posterior stroma of the recipient, 50 μ above the corneal thinnest point, into which a smooth cannula for air injection can be introduced
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