Management of Type 2 Bubble Formed During Big Bubble Deep Anterior Lamellar Keratoplasty.

Abstract:

PURPOSE:To review the outcome of 3 techniques for managing type 2 bubbles (between Descemet's membrane [DM] and stroma) formed during big bubble (BB) deep anterior lamellar keratoplasty (DALK) in different corneal pathologies. METHODS:This is an interventional case series study of patients with type 2 bubbles formed during BB DALK. Three techniques to complete DALK are described: the first is a DM baring technique similar to Anwar's BB technique, the second is the microbubble incision technique to preserve the pre-Descemetic support to DM, and the third is done in eyes with combined type 1 and type 2 BB (mixed bubble), where the type 1 bubble is opened and surgery is completed avoiding the type 2 bubble. RESULTS:Thirty-one eyes of 31 patients were included. The DM baring technique has a high rate of conversion to penetrating keratoplasty (12 of 16 eyes). In the other 2 techniques (which did not bare DM), DALK could be completed in all 15 cases with intact DM. Double anterior chamber is a relatively common complication after type 2 BB, even with an intact DM. CONCLUSIONS:DM baring techniques should be avoided in eyes with type 2 BB. Instead, deep stromal dissection searching for an incomplete type 1 bubble or using one of the manual dissection techniques as a guide to the clear pre-Descemetic stroma is safer and more reliable.

journal_name

Cornea

journal_title

Cornea

authors

Goweida MB,Ragab AM,Liu C

doi

10.1097/ICO.0000000000001815

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

189-193

issue

2

eissn

0277-3740

issn

1536-4798

journal_volume

38

pub_type

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