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Technique for Ensuring Type I Bubble Formation for Pre-Descemet Endothelial Keratoplasty Preparation

Saint-Jean, Alejandro MD*,†; Soper, Mark BS, CEBT, CTBS; Den Beste, Kyle MD*; Iverson, Shawn DO*; Price, Marianne O. PhD§; Price, Francis W. MD*

doi: 10.1097/ICO.0000000000002051

Purpose: To describe a technique that ensures the production of a type 1 bubble when preparing pre-Descemet endothelial keratoplasty (PDEK) grafts with a high rate of predictability.

Methods: Donor corneas were placed on a support disc, and a blunt instrument was used to score 360 degrees of the peripheral Descemet membrane and endothelium just inside the trabecular meshwork. Air was injected in several short bursts and several stages with a 30-gauge needle on a 3-mL syringe 2.0 mm away from the limbus to create a type 1 big bubble. The technique was tested by 2 operators (M.S. and A.S.-J.) in 26 human donor corneas, including 12 for possible transplantation, over a 9-month period. Anterior segment optical coherence tomograph (AS-OCT) was performed in 1 case proving a type 1 bubble.

Results: A type 1 big bubble was successfully created in 24 of 26 attempted cases (92.3%). The technique was used successfully to obtain PDEK tissue for transplant in 9 eyes. One case was not technically acceptable because of diffuse cell loss (>10%); however, the bubble preparation itself was successful. One case had a mixed bubble because of incomplete scoring, resulting in a Descemet membrane endothelial keratoplasty graft used for transplant. One case failed to form any bubble likely because the scoring was too central. Of a total of 26 cases, 14 cases were for practice.

Conclusions: The Soper technique significantly improved the success rate of creating a type 1 bubble for PDEK preparation.

*Price Vision Group, Indianapolis, IN;

Clinica Baviera, Tarragona, Spain;

VisionFirst Indiana Lions Eye Bank, Indianapolis, IN; and

§Cornea Research Foundation of America, Indianapolis, IN.

Correspondence: Alejandro Saint-Jean, MD, Price Vision Group, 9002 North Meridian St # 100, Indianapolis, IN 46260 (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 January 14, 2019

Received in revised form May 17, 2019

Accepted May 21, 2019

Online date: July 3, 2019

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