title: The Big-Bubble Full Femtosecond Laser-Assisted Technique in Deep Anterior Lamellar Keratoplasty.
abstract: OBJECTIVE
  To describe the big-bubble full femtosecond laser-assisted (BBFF) technique, which could be helpful in standardizing the big-bubble technique in deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  Ten eyes of 10 consecutive patients affected by keratoconus underwent the BBFF technique using the 150-kHz IntraLase femtosecond laser (Intra-Lase FS Laser; Abbott Medical Optics, Inc., Santa Ana, CA). A 9-mm diameter metal mask with a single fissure 0.7 mm wide oriented at the 12-o'clock position was positioned into the cone, over the laser glass. The laser performed a ring lamellar cut (internal diameter = 3 mm; external diameter = 8 mm) 100 µm above the thinnest point, with the photodisruption effectively occurring only in the corneal stroma corresponding to the fissure to create a deep stromal channel; subsequently, an anterior side cut created an arcuate incision, from the corneal surface to the deep stromal channel on the mask's opening site. The mask was removed and the laser performed a full lamellar cut 200 µm above the thinnest point to create a lamella. After the removal of the lamella, the air needle was inserted into the stromal channel and air was injected to achieve a big bubble.
  
  
  RESULTS
  The big bubble was achieved in 9 eyes (all type 1 bubbles) and all procedures were completed as DALK.
  
  
  CONCLUSIONS
  Preliminary results suggest that the BBFF technique could help in standardizing the big-bubble technique in DALK, reducing the "learning curve" for surgeons who approach this technique and the risks of intraoperative complications.
authors.forename: Luca
authors.initials: L
authors.lastname: Buzzonetti
authors.forename: Gianni
authors.initials: G
authors.lastname: Petrocelli
authors.forename: Paola
authors.initials: P
authors.lastname: Valente
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Iarossi
authors.forename: Roberta
authors.initials: R
authors.lastname: Ardia
authors.forename: Sergio
authors.initials: S
authors.lastname: Petroni
authors.forename: Rosa
authors.initials: R
authors.lastname: Parrilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000388:Air; D002648:Child; D003315:Cornea / Q000503:physiopathology; D048988:Corneal Surgery, Laser / Q000379:methods*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014792:Visual Acuity / Q000502:physiology