“Small bubble technique” helps “big bubble technique”

Corneal transplant surgery has recently seen rapid and exciting changes on multiple fronts, following several previous decades of only minimal change after introduction of the operating microscope and monofilament sutures. New transplantation techniques are primarily taking off on three fronts: endothelial keratoplasty (EK), femtosecond laser assisted penetrating keratoplasty (PK), and anterior lamellar keratoplasty (ALK). All three of these procedures address one of the primary limitations of traditional PK—that is, poor wound healing.

The increasing use of EK to treat dysfunctional corneal endothelium is a prime example of how rapidly a new technique may be adopted once it evolves to the point that it produces superior outcomes and can be reliably performed. For example, the first EK technique not requiring corneal sutures to hold the graft in place was introduced about nine years ago.1 Subsequent improvements, including methods to reduce the incision length and amount of tissue removed from the recipient eye, resulted in the iteration known as Descemet’s stripping with endothelial keratoplasty (DSEK), introduced in late 2003.2^–4 At that time the number of EK procedures was so low that they were not even tracked by the Eye Bank Association of America (EBAA). By the time the EBAA began tracking use of EK procedures in 2005, they represented 4.5% of the grafts performed in the United States. By 2006, …