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High-Resolution Optical Coherence Tomography–Guided Donor Tissue Preparation for Descemet Membrane Endothelial Keratoplasty Using the Reverse Big Bubble Technique

Cabot, Florence MD; Kankariya, Vardhaman P. MD; Ruggeri, Marco PhD; Yoo, Sonia H. MD; Vaddavalli, Pravin K. MD; Parel, Jean-Marie PhD; Kymionis, George D. MD, PhD

doi: 10.1097/ICO.0000000000000070

Purpose: The aim of this study was to assess the feasibility of high-resolution spectral domain optical coherence tomography (HR-SDOCT) to guide donor tissue preparation in Descemet membrane endothelial keratoplasty using the reverse big bubble technique.

Methods: Three corneoscleral discs were included in this ex vivo experimental study. A 27-G cannula was introduced into each cornea at the periphery by 3 different surgeons. Each surgeon attempted to achieve the ideal depth (pre-Descemetic plane) of the tip of the cannula for air injection to produce the reverse big bubble to separate the Descemet membrane (DM) from the posterior stroma. A supine optical coherence tomography system built at the Ophthalmic Biophysics Center of the Bascom Palmer Eye Institute was used to estimate in real-time the depth reached by the tip of the cannula in the posterior stroma during tissue preparation.

Results: After air injection, 1 successful big bubble was obtained, while each of the other corneoscleral discs had intrastromal emphysema and DM perforation. On HR-SDOCT evaluations, artifacts were noticed at the tip of the cannula. The successful big bubble demonstrated the separation of the DM and the stroma without intrastromal hyperreflectivity. Emphysema was visualized on the HR-SDOCT as a hyperdense intrastromal area shadowing the posterior structures of the anterior chamber.

Conclusions: The HR-SDOCT–guided reverse big bubble technique may be a useful method to prepare donor tissue in Descemet membrane endothelial keratoplasty. Further improvements in high-resolution optical coherence tomography technology are needed this promising technique.

*Anne Bates Leach Eye Hospital, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL;

Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL;

Faculty of Medicine, University of Crete, School of Health Sciences, Voutes, Heraklion, Crete, Greece; and

§LV Prasad Eye Institute, Hyderabad, India.

Reprints: George D. Kymionis, University of Crete-School of Health Sciences, GR 71 003 Voutes, Heraklion, Crete, Greece (e-mail:

Supported in part by the Florida Lions Eye Bank, USAMRMC Department of Defense W81XWH-09-1-0674 BPEI Center for Ophthalmic Innovation, an unrestricted grant from the Research to Prevent Blindness, NIH EY R44EY01900 to 02, 2R44EY018021, and P30 EY014801 and the Henri and Flore Lesieur Foundation (J.-M.P.).

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

Received September 10, 2013

Accepted December 18, 2013

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