title: Blunt scissors stromal dissection technique for deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  We describe a modified technique for performing lamellar dissection in deep anterior lamellar keratoplasty after failure to achieve a "big bubble" detachment of Descemet's membrane (DM) with deep intrastromal pneumatic injection.
  
  
  METHODS
  The technique utilizes blunt lamellar dissection with blunt-tipped corneal mini scissors as an alternative to a crescent blade, which can be difficult for surgeons to master and is associated with a high risk of perforation.
  
  
  RESULTS
  Other techniques of blunt dissection, such as the Melles technique, cannot be utilized after failure to achieve a big bubble, as emphysema in the stroma prevents visualization of the spatula. In contrast, our blunt scissors lamellar dissection technique takes advantage of the emphysema and microdetachments of DM created by the pneumatic injection.
  
  
  CONCLUSIONS
  This technique provides deep anterior lamellar keratoplasty surgeons with a simple, alternative method of baring DM or achieving a pre-DM plane with minimal residual stroma, after failure to achieve a big bubble.
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Didar S
authors.initials: DS
authors.lastname: Anwar
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Kruger
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: V Vinod
authors.initials: VV
authors.lastname: Mootha
keywords: DALK; big bubble; blunt; dissection; scissors