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Rupture Pressure of the Posterior Lamella Obtained During Big-Bubble Deep Anterior Lamellar Keratoplasty

McKee, Hamish D. FRANZCO*; Barua, Ankur MB, ChB*; Brahma, Arun K. MD, FRCOphth*; Jhanji, Vishal MD; Carley, Fiona M. FRCOphth*

doi: 10.1097/ICO.0b013e31823f8e1b
Basic Investigation

Purpose: To investigate the pressure required to rupture the posterior lamella obtained during the presumed Descemet membrane–baring big-bubble technique of deep anterior lamellar keratoplasty (DALK).

Methods: DALK using the big-bubble technique was carried out on donor corneoscleral discs mounted on an artificial anterior chamber. Once the anterior lamella was removed, the chamber was connected to a mercury manometer. The pressure inside the chamber was increased until rupture occurred or the manometer reached its measurement limit.

Results: The deep lamella ruptured at 252 mm Hg in one cornea, at 270 mm Hg in another, and had not ruptured at 300 mm Hg (upper limit of the manometer) in the remaining 18 donor corneas.

Conclusions: The posterior lamella of big-bubble DALK probably confers significant structural integrity on the globe.

*Ophthalmology Department, Manchester Royal Eye Hospital, Manchester, United Kingdom

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong.

Reprints: Hamish D. McKee, Manchester Royal Eye Hospital, Oxford Rd, Manchester M13 9WL, United Kingdom (e-mail:

Supported by the NIHR Manchester Biomedical Research Centre.

The authors state that they have no conflicts of interest to disclose.

Received April 18, 2011

Accepted June 2, 2011

© 2012 Lippincott Williams & Wilkins, Inc.