Variant of the big bubble technique in deep anterior lamellar keratoplasty

We describe a variant of the big-bubble technique that involves placement of a stromal corneal nick and nontraumatic intrastromal insertion of a blunt cannula following anterior lamellar keratectomy. The goal of this technique is to reduce the risk for intraoperative corneal perforation and to obtain a large air bubble between Descemet's membrane and the corneal stroma. Deep anterior lamellar keratoplasty is easier and safer with this technique.