"Large-bubble" modification of the "big-bubble" technique for performing maximum-depth anterior lamellar keratoplasty.
OBJECTIVE
To describe a new technique for performing maximum-depth anterior lamellar keratoplasty.


METHODS
This was a case series study of a novel method. We combined shallow trephination of the cornea with superficial injection of air in 15 cases. This resulted in formation of a large bubble over Descemet membrane extending to the peripheral cornea. We deflated the bubble at the trephination wound and excised the button from the host completely. The follow-up was from 3 to 8 months. The best spectacle-corrected visual acuity, intraocular pressure, corneal clarity, endothelial cell count, and corneal thickness were recorded preoperatively and 3 and 6 months postoperatively.


RESULTS
Successful access to intact bare Descemet membrane was obtained in all but one case, which required conversion to penetrating keratoplasty. All corneas were clear at the end of follow-up. We found a significant difference in the endothelial cell counts in the cases that we compared. The postoperative central corneal thickness increased significantly compared with preoperative levels.


CONCLUSIONS
The early outcomes in our initial series of cases using the "large-bubble" technique suggest that it is a fast effective method.
Behrooz
Mahmoud Jabbarvand
MJ
Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.
Daneshgar
Farid
F
D000293:Adolescent; D000328:Adult; D000388:Air; D002452:Cell Count; D003315:Cornea / Q000502:physiology; D003318:Corneal Opacity / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult