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Modification of the Miyake–Apple Technique for Simultaneous Anterior and Posterior Video Imaging of Wet Laboratory–Based Corneal Surgery

Tan, Johnson C. H. MBBS, FRCSEd (Ophth), FAMS; Meadows, Howard BEd, BMus, BSc, MSc; Gupta, Aanchal MBBS, FRANZCO; Yeung, Sonia N. MD, PhD, FRCSC; Moloney, Gregory MBBS, FRCSC, FRANZCO

doi: 10.1097/ICO.0000000000000060

Purpose: The aim of this study was to describe a modification of the Miyake–Apple posterior video analysis for the simultaneous visualization of the anterior and posterior corneal surfaces during wet laboratory–based deep anterior lamellar keratoplasty (DALK).

Methods: A human donor corneoscleral button was affixed to a microscope slide and placed onto a custom-made mounting box. A big bubble DALK was performed on the cornea in the wet laboratory. An 11-diopter intraocular lens was positioned over the aperture of the back camera of an iPhone. This served to video record the posterior view of the corneoscleral button during the big bubble formation. An overhead operating microscope with an attached video camcorder recorded the anterior view during the surgery.

Results: The anterior and posterior views of the wet laboratory–based DALK surgery were simultaneously captured and edited using video editing software. The formation of the big bubble can be studied.

Conclusions: This video recording camera system has the potential to act as a valuable research and teaching tool in corneal lamellar surgery, especially in the behavior of the big bubble formation in DALK.

Supplemental Digital Content is Available in the Text.

*Division of Cornea and External Disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada;

National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore;

Department of Ophthalmology and Visual Sciences, Surgery Teaching and Research Wet Laboratory, University of British Columbia, Vancouver, BC, Canada; and

§South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.

Reprints: Johnson C. H. Tan, Eye Care Centre, Cornea Unit, 2550 Willow St, Vancouver, British Columbia, Canada V5Z 3N9 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received October 27, 2013

Accepted November 25, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.