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Dissection Plane in Deep Anterior Lamellar Keratoplasty Using the Big-Bubble Technique

Jafarinasab, Mohammad Reza MD; Rahmati-Kamel, Mohsen MD; Kanavi, Mozhgan Rezaei MD; Feizi, Sepehr MD

doi: 10.1097/ICO.0b013e3181ba7016
Clinical Science

Purpose: To find the level of dissection in keratoconic corneas undergoing deep anterior lamellar keratoplasty (DALK) using the big-bubble technique.

Methods: In 3 keratoconic eyes that underwent DALK, the operation was converted into penetrating keratoplasty after complete big-bubble formation because of extensive tear in Descemet's membrane (DM) during stromal excision. The corneal stroma and DM taken from these eyes were submitted for light and transmission electron microscopy.

Results: Both light and transmission electron microscope revealed a thin layer of corneal stroma adhered to DM in all cases. In 2 eyes, the residual stromal thickness was almost constant (6.4 μm and 12.3 μm), whereas it varied from 9.5 μm to 25.8 μm in the other one.

Conclusion: Dissection plane in DALK using the big-bubble technique can be within corneal stroma rather than exactly between stroma and DM. Various corneal pathologies as well as different techniques of dissection may have influence on this level.

From the Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University (M.C.), Tehran, Iran.

Received for publication March 12, 2009; revision received July 23, 2009; accepted July 31, 2009.

There is no financial or propriety interest in any materials used in this manuscript.

Reprints: Sepehr Feizi, Ophthalmology Department and Ophthalmic Research Center, Labbafinejad Medical Center, Boostan 9 St. Pasdaran Ave., Tehran 16666, Iran (e-mail:

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