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Residual corneal stroma in big-bubble deep anterior lamellar keratoplasty: a histological study in eye-bank corneas
  1. Hamish D McKee1,
  2. Luciane C D Irion2,
  3. Fiona M Carley1,
  4. Vishal Jhanji3,
  5. Arun K Brahma1
  1. 1Manchester Royal Eye Hospital, Manchester, UK
  2. 2National Specialist Ophthalmic Pathology Service, Manchester, UK
  3. 3Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
  1. Correspondence to Dr Hamish D McKee, Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK; hamishmckee{at}


Aim To determine if residual corneal stroma remains on the recipient posterior lamella in big-bubble deep anterior lamellar keratoplasty (DALK).

Methods Pneumodissection using the big-bubble technique was carried out on eye-bank corneas mounted on an artificial anterior chamber. Samples that had a successful big-bubble formation were sent for histological evaluation to determine if any residual stroma remained on the Descemet membrane (DM).

Results Big-bubble formation was achieved in 32 donor corneas. Two distinct types of big-bubble were seen: the bubble had either a white margin (30 corneas) or a clear margin (two corneas). The posterior lamellae of all the white margin corneas showed residual stroma on DM with a mean central thickness of 7.0 μm (range 2.6–17.4 μm). The clear margin corneas showed no residual stroma on DM.

Conclusion It should no longer be assumed that big-bubble DALK, where the bubble has a white margin, routinely bares DM. True baring of DM may only occur with the less commonly seen clear margin bubble.

  • Deep anterior lamellar keratoplasty
  • big-bubble
  • cornea
  • neoplasia
  • angiogenesis
  • imaging
  • treatment surgery
  • optics and refraction
  • treatment lasers
  • anterior chamber
  • degeneration
  • inflammation
  • medical education
  • wound healing
  • eye (tissue) banking
  • degeneration
  • dystrophy
  • intraocular pressure
  • treatment surgery

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  • Funding This work was supported by the NIHR Manchester Biomedical Research Centre.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.