title: Femtosecond-Assisted Big Bubble: A Feasibility Study.
abstract: OBJECTIVE
  To evaluate the feasibility of femtosecond laser-assisted (FA) tunnel creation as a pretreatment for creating a big bubble (BB) to pneumo-dissect the corneal stroma from Descemet membrane.
  
  
  METHODS
  Five human cadaver eyes received pretreatment using a femtosecond laser. An intrastromal tunnel, along with a side cut, was achieved using customized femtosecond corneal disruption (custom mask). Before treatment, optical coherence tomography was performed and the intrastromal tunnel was intended to achieve a parallel orientation with respect to the corneal endothelial cell layer (50 µm above the endothelium). Surgical dissection of the side cut using a Sinskey hook was performed, followed by insertion of a deep anterior lamellar keratoplasty cannula into the tunnel and pneumo-dissection (BB). All corneas after treatment were prepared for histologic evaluation (light microscopy).
  
  
  RESULTS
  FA pretreatment was successful in all 5 cadaveric corneas, and the BB was achieved in all eyes as well. Histologic evaluation of the corneas revealed complete separation of Descemet membrane and stroma in all eyes, with no remaining stroma attached to Descemet membrane and no signs of perforation.
  
  
  CONCLUSIONS
  FABB seems feasible because pneumo-dissection of the corneal stroma from Descemet membrane was achieved in all human cadaver corneas of this experimental study. Optical coherence tomography, corneal histology, and macroscopic evaluation revealed complete Descemet-stromal separation.
authors.affiliation: *Department of Cornea, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL;†Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL; and‡Department of Ocular Pathology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Vasilios F
authors.initials: VF
authors.lastname: Diakonis
authors.forename: Sonia H
authors.initials: SH
authors.lastname: Yoo
authors.forename: Victor
authors.initials: V
authors.lastname: Hernandez
authors.forename: Vardhaman P
authors.initials: VP
authors.lastname: Kankariya
authors.forename: Florence
authors.initials: F
authors.lastname: Cabot
authors.forename: Maria P
authors.initials: MP
authors.lastname: Fernandez-Jimenez
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Parel
mesh_terms: D000328:Adult; D000368:Aged; D003319:Corneal Stroma / Q000601:surgery*; D003886:Descemet Membrane / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use; D045423:Microbubbles; D042282:Microdissection / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps; D000072836:Surgical Wound; D041623:Tomography, Optical Coherence