Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty

TLDR

The study introduces a lamellar keratoplasty method that uses air injection to detach and bare Descemet's membrane. The procedure begins with a partial‑thickness corneal trephination, followed by deep bevel‑down needle insertion into paracentral stroma and air injection to create a bubble; subsequent anterior lamellar keratectomy, opening the bubble, and lifting and excising the residual stroma with an iris spatula, blade, and scissors completes the technique. The technique reliably generates a large air bubble between Descemet's membrane and stroma and is reported to be faster, safer, and easier than prior methods.

Abstract

We describe a lamellar keratoplasty technique to bare Descemet's membrane in which air is injected to detach the central Descemet's. After a partial-thickness corneal trephination is performed, a disposable needle is inserted, deeply and bevel down, into the paracentral corneal stroma and air is injected. In most cases, this forms a large air bubble between Descemet's membrane and the corneal stroma. After anterior lamellar keratectomy is performed, a small opening is made in the air bubble and the remaining stromal layers are lifted with an iris spatula, severed with a blade, and excised with scissors. This technique is faster, safer, and easier to perform than previous methods.