Deep Anterior Lamellar Keratoplasty with Central Descemet's Membrane Baring in Eyes with Type 2 Bubble

To review the outcomes of deep anterior lamellar keratoplasty (DALK) with formed type 2 bubble, managed with microbubbles-assisted manual dissection combined with central baring of Descemet's membrane (DM).

This is a retrospective interventional case series including eyes with formed type 2 bubble during DALK, and opacified pre-Descemet's layer (PDL), done between January 2017 and February 2022. In eyes with type 2 bubbles, microbubbles-assisted manual dissection was done followed by baring of DM only in the central 4-5 mm. In eyes with mixed bubbles, the type 1 bubble is used as a guide to the PDL followed by central DM baring. Removal of the PDL was done either by peeling or cutting with scissors according to the thickness of the stroma to be excised. Patients were followed up in the clinic, and the data were collected at 3-, 6-, and 12-month postoperative visits.

A total of 15 eyes of 14 patients were included in the study (7 females and 7 males). All cases were completed as DALK and showed improvement in visual acuity with mean logMAR visual acuity of 1.12 ± 0.8 at 3 months and 0.7 ± 0.49 at 1 year postoperatively. The mean final logMAR corrected distance visual acuity was 0.2 ± 0.18. Complications included DM detachment and double anterior chamber (n = 6), DM microperforation (n = 2), stromal rejection (n = 1), and pupillary block after air injection (n = 1).

DALK with central baring of DM offers a promising solution for eyes with opacified PDL and type 2 bubble, resulting in a clear visual axis and low risk of conversion to penetrating keratoplasty.