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doi: 10.1097/ICO.0b013e31824a226f
Clinical Science

Microbubble Incision as a New Rescue Technique for Big-Bubble Deep Anterior Lamellar Keratoplasty With Failed Bubble Formation

Riss, Stephan MD*; Heindl, Ludwig M. MD; Bachmann, Björn O. MD*; Kruse, Friedrich E. MD, PhD*; Cursiefen, Claus MD, PhD*,†

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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/mm2) 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.

© 2013 Lippincott Williams & Wilkins, Inc.


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