rss
Br J Ophthalmol 2007;91:1369-1373 doi:10.1136/bjo.2006.113357
  • Surgical techniques

Use of a “small-bubble technique” to increase the success of Anwar’s “big-bubble technique” for deep lamellar keratoplasty with complete baring of Descemet’s membrane

  1. Anand Parthasarathy1,2,
  2. Yong Ming Por1,2,
  3. Donald T H Tan1,2,3
  1. 1
    Singapore National Eye Centre
  2. 2
    Singapore Eye Research Institute
  3. 3
    National University of Singapore
  1. Professor Donald Tan, Singapore National Eye Center, 11, Third Hospital Avenue, Singapore 168751; snecdt{at}pacific.net.sg
  • Accepted 1 May 2007

Abstract

Purpose: To describe a quick and simple “small-bubble” technique to immediately determine the success of attaining complete Descemet’s membrane (DM) separation from corneal stroma through Anwar’s “big-bubble” technique of deep anterior lamellar keratoplasty (DALK) for complete stromal removal.

Methods: A partial trephination was followed by a lamellar dissection of the anterior stroma. Deep stromal air injection was then attempted to achieve the big bubble to help separate the stroma from the DM. To confirm that a big bubble had been achieved, a small air bubble was injected into the anterior chamber (AC) through a limbal paracentesis. If the small bubble is then seen at the corneal periphery, it confirms that the big-bubble separation of DM was successful because the convex nature of the bubble will cause it to protrude posteriorly, forcing the small AC bubble to the periphery. If the small AC bubble is not seen in the corneal periphery, this means that it is present in the centre, beneath the opaque corneal stroma, and therefore the big bubble has not been achieved.

Results: We used the small-bubble technique to confirm the presence of the big bubble in three (one keratoconus, one interstitial keratitis and one dense corneal scar) out of 41 patients who underwent DALK. The small-bubble technique confirmed that the big bubble was achieved in the eye of all three patients. Complete stromal removal with baring of the DM was achieved, and postoperatively all three eyes achieved best corrected vision of 6/6.

Conclusion: The small-bubble technique can be a useful surgical tool for corneal surgeons attempting lamellar keratoplasty using the big-bubble technique. It helps in confirming the separation of DM from the deep stroma, which is important in achieving total stromal replacement. It will help to make the transition to lamellar keratoplasty smoother, enhance corneal graft success and improve visual outcomes in patients.

Footnotes

  • The authors do not have a proprietary or financial interest in the products used in the patients in this case series.

  • Competing interests: None declared.

This Article

  1. Abstract
  2. Full text
  3. PDF

Responses

  1. Submit a response
  2. No responses published

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.