"Large-bubble" modification of the "big-bubble" technique for performing maximum-depth anterior lamellar keratoplasty

To describe a new technique for performing maximum-depth anterior lamellar keratoplasty.

This was a case series study of a novel method. We combined shallow trephination of the cornea with superficial injection of air in 15 cases. This resulted in formation of a large bubble over Descemet membrane extending to the peripheral cornea. We deflated the bubble at the trephination wound and excised the button from the host completely. The follow-up was from 3 to 8 months. The best spectacle-corrected visual acuity, intraocular pressure, corneal clarity, endothelial cell count, and corneal thickness were recorded preoperatively and 3 and 6 months postoperatively.

Successful access to intact bare Descemet membrane was obtained in all but one case, which required conversion to penetrating keratoplasty. All corneas were clear at the end of follow-up. We found a significant difference in the endothelial cell counts in the cases that we compared. The postoperative central corneal thickness increased significantly compared with preoperative levels.

The early outcomes in our initial series of cases using the "large-bubble" technique suggest that it is a fast effective method.