title: Dissection plane in deep anterior lamellar keratoplasty using the big-bubble technique.
abstract: OBJECTIVE
  To find the level of dissection in keratoconic corneas undergoing deep anterior lamellar keratoplasty (DALK) using the big-bubble technique.
  
  
  METHODS
  In 3 keratoconic eyes that underwent DALK, the operation was converted into penetrating keratoplasty after complete big-bubble formation because of extensive tear in Descemet's membrane (DM) during stromal excision. The corneal stroma and DM taken from these eyes were submitted for light and transmission electron microscopy.
  
  
  RESULTS
  Both light and transmission electron microscope revealed a thin layer of corneal stroma adhered to DM in all cases. In 2 eyes, the residual stromal thickness was almost constant (6.4 μm and 12.3 μm), whereas it varied from 9.5 μm to 25.8 μm in the other one.
  
  
  CONCLUSIONS
  Dissection plane in DALK using the big-bubble technique can be within corneal stroma rather than exactly between stroma and DM. Various corneal pathologies as well as different techniques of dissection may have influence on this level.
authors.affiliation: Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University, Boostan 9 St., Pasdaran Ave., Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Jafarinasab
authors.forename: Mohsen
authors.initials: M
authors.lastname: Rahmati-Kamel
authors.forename: Mozhgan Rezaei
authors.initials: MR
authors.lastname: Kanavi
authors.forename: Sepehr
authors.initials: S
authors.lastname: Feizi
mesh_terms: D000328:Adult; D003319:Corneal Stroma / Q000473:pathology* / Q000601:surgery; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000473:pathology* / Q000601:surgery; D004210:Dissection / Q000379:methods; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D055815:Young Adult