Couples of Bubbles for Successful Big-Bubble to Bare Descemets Membrane in Anterior Lamellar Keratoplasty
Purpose
To describe a lamellar keratoplasty technique to bare Descemet’s membrane in which multiple air bubbles are injected into the anterior chamber to delineate Descemet’s membrane level followed by air injection into the stroma to detach the central Descemet’s.
Methods
After a partial-thickness corneal trephination is performed, multiple air bubbles are injected into the anterior chamber through a paracentesis. Then a needle with bevel down is inserted deeply just above the Descemet’s membrane - guided by the air bubbles in the anterior chamber - till a descmets indentation is seen followed be air bubble injection. This forms a large air bubble between Descemet’s membrane and the corneal stroma with peripheral shifting of the small bubbles, which confirm the successful separation. Then a vescoelastic substance is injected inside the bubble to keep the Descemet's membrane away from the stroma followed by anterior keratectomy. An opening then is made in the center of the remaining stroma to deflate the air. A scissor is introduced through the opening to cut the remaining stroma.
Results
This technique is faster, safer, and easier to perform than previous methods.
Conclusion
This technique is faster, safer, and easier to perform than previous method.