TechniquesEnlarging the Big-Bubble During Deep Anterior Lamellar KeratoplastyMcKee, Hamish D. FRANZCO; Jhanji, Vishal MD; Brahma, Arun K. MD, FRCOphthAuthor Information *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: firstname.lastname@example.org). The authors have no funding or conflicts of interest to disclose. Received January 29, 2012 Accepted March 28, 2012 Cornea: April 2013 - Volume 32 - Issue 4 - p 520-522 doi: 10.1097/ICO.0b013e318257f7aa Buy Metrics Abstract Purpose: During big-bubble deep anterior lamellar keratoplasty, a bubble that is not large enough can be formed. Further air injection can result in the rupture of the posterior lamella, necessitating conversion to penetrating keratoplasty. We describe some techniques to safely enlarge the big-bubble in such a circumstance. Methods: In cases in which a white-margin bubble forms that has extended to the trephination margin, the bubble is collapsed and the margins are extended by blunt dissection. For cases of an undersized clear-margin bubble, the bubble is enlarged by gentle injection of a cohesive ophthalmic viscosurgical device into the bubble cavity. Results: Using these techniques, big-bubbles were safely extended beyond the trephination margin for both white- and clear-margin bubbles. Conclusions: An undersized big-bubble can safely be extended using blunt dissection for white-margin bubbles and ophthalmic viscosurgical device injection for clear-margin bubbles. Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.