Deep anterior lamellar keratoplasty (DALK) is preferred over conventional penetrating keratoplasty (PKP) for the treatment of anterior corneal opacities or ectasias due to decreased risk of endothelial rejection. However, DALK remains surgically challenging, largely due to challenges associated with achieving consistent pneumo-dissection of posterior stroma from the underlying pre-Descemet's or Descemet's membrane (DM). Air must be injected at sufficient depth in the corneal stroma in order to achieve successful pneumo-dissection, but advancing a needle too deep into the cornea can lead to perforation of DM. We describe here a novel technique using a handheld slit lamp (Eidolon model 510L, Eidolon Optical LLC, Natick, MA, USA) to assist in creation of the big-bubble in DALK surgery. Use of a handheld slit beam intraoperatively is a safe, relatively inexpensive, and effective technique for increasing the success of big-bubble formation in DALK procedures.
Bibliographical noteFunding Information:
This study was supported by an unrestricted grant from the Minnesota Lions Vision Foundation.
© 2018 Annals of Eye Science. All rights reserved.
- Big bubble technique
- Deep anterior lamellar keratoplasty (DALK)
- Slit beam