title: Enlarging the big-bubble during deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  During big-bubble deep anterior lamellar keratoplasty, a bubble that is not large enough can be formed. Further air injection can result in the rupture of the posterior lamella, necessitating conversion to penetrating keratoplasty. We describe some techniques to safely enlarge the big-bubble in such a circumstance.
  
  
  METHODS
  In cases in which a white-margin bubble forms that has extended to the trephination margin, the bubble is collapsed and the margins are extended by blunt dissection. For cases of an undersized clear-margin bubble, the bubble is enlarged by gentle injection of a cohesive ophthalmic viscosurgical device into the bubble cavity.
  
  
  RESULTS
  Using these techniques, big-bubbles were safely extended beyond the trephination margin for both white- and clear-margin bubbles.
  
  
  CONCLUSIONS
  An undersized big-bubble can safely be extended using blunt dissection for white-margin bubbles and ophthalmic viscosurgical device injection for clear-margin bubbles.
authors.affiliation: Manchester Royal Eye Hospital, Manchester, United Kingdom. hamishmckee@gmail.com
authors.forename: Hamish D
authors.initials: HD
authors.lastname: McKee
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: Arun K
authors.initials: AK
authors.lastname: Brahma
mesh_terms: D000388:Air; D003316:Corneal Diseases / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000601:surgery*; D006801:Humans; D014792:Visual Acuity