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Updated: Jun 23, 2026
Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
Histopathology of deep anterior lamellar keratoplasty with pneumatic dissection: the "big-bubble" technique
Pauline Lim1, Jay C Bradley, George J Harocopos
1Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA 95817, USA.
Purpose:
To describe characteristic histopathologic markers in deep anterior lamellar keratoplasty (DALK) using pneumatic dissection: Anwar "big-bubble" technique.
Methods:
Case reports. Deep stromal buttons from 2 patients with keratoconus who had undergone DALK surgery using the "big-bubble" technique were examined by light microscopy.
Results:
The histopathology of excised corneal buttons demonstrated multiple intrastromal spaces consistent with air bubbles. Apical stromal thinning seen clinically was not as readily appreciated on histopathology.
Conclusions:
Pneumatic dissection in DALK produces diffuse intrastromal air bubbles that may mask the corneal thinning that usually characterizes keratoconus histopathologically. This is a characteristic finding of which ocular pathologists and corneal surgeons should be aware.
