Big-bubble Deep Anterior Lamellar Keratoplasty Research Articles

Deep anterior lamellar keratoplasty performed with the femtosecond laser zigzag incision for the treatment of stromal corneal pathology and ectatic disease

We describe a variation of the big-bubble deep anterior lamellar keratoplasty (DALK) technique using the femtosecond laser zigzag incision. This technique allows precise depth visualization for air-needle placement in the posterior stroma based on the lamellar and posterior laser cuts, thus minimizing the risk for perforation of Descemet membrane. The matching donor and host tissue zigzag cut allows more precise tissue apposition and greater surface area for healing. The angled anterior donor and host junction allows a smooth transition for improved visual outcomes. If the big-bubble- Descemet membrane dissection fails, the surgeon can convert to a full-thickness graft while retaining the benefits of the femtosecond laser incision.

Deep anterior lamellar keratoplasty

AbstractDespite the long term risk of endothelial rejection, full‐thickness corneal transplantation is still considered the gold standard surgery for replacing a diseased cornea. Deep anterior lamellar keratoplasty (DALK) is not a new procedure, but in the past, its use has been of limited popularity owing to the challenging, lengthy and tedious surgery involved. With the advent of newer surgical techniques and instruments for performing lamellar corneal surgery, DALK has gained in popularity. This presentation discusses the techniques for performing the procedure as well as the clinical outcomes, especially focusing on Big bubble DALK. Results will be compared with the outcomes of penetrating keratoplasty (PK). Results suggest that DALK is the logical choice in the surgical management of corneal stromal disease, in presence of a functional endothelium.

Simple test to confirm cleavage with air between Descemet's membrane and stroma during big-bubble deep anterior lamellar keratoplasty

We describe a simple test to confirm big-bubble formation in deep anterior lamellar keratoplasty by observing the position and movements of small air bubbles injected into the anterior chamber through a limbal paracentesis. The test also allows evaluation of the extension of Descemet's membrane cleavage from the posterior stroma relative to the margins of the corneal trephination.