Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus

Feizi, Sepehr; Javadi, Mohammad Ali; Daryabari, Seyed-Hashem

doi:10.1136/bjophthalmol-2015-307111

Cited by 37 publications

(20 citation statements)

References 26 publications

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“…A large trephination size has been reported to be associated with an increase in the probability of successful big bubble formation in keratoconus eyes [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Borderie¹,

Touhami²,

Georgeon³

et al. 2018

Journal of Ophthalmology

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Objective Big bubble (BB)-deep anterior lamellar keratoplasty (DALK) has become the reference transplantation technique for corneal stromal disorders. Type 1 BB is the desired aspect but it is not constant. We aimed to determine the predictive factors of type 1 BB success. Methods Observational cohort study including 77 consecutive eyes of 77 patients undergoing DALK by one surgeon at a single reference center without any selection. Clinical and spectral domain optical coherence tomography data were collected pre- and postoperatively. Results Stromal scars were found in 91.8% of cases and were located in the anterior (90.9%), mid (67.5%), and posterior (36.4%) stroma. Type 1 BB (49.3% of cases) was significantly associated with the absence of scars in the posterior stroma, stage 1–3 keratoconus, and deep trephination. Among eyes with posterior scars, type 1 BB was associated with higher minimal corneal thickness, maximum-minimum corneal thickness < 220 μm, and diagnosis other than keratoconus. Eyes with type 1 BB featured significantly thinner residual stromal bed (22 ± 8 µm versus 61 ± 28 µm), thinner corneas at 12, 24, and 36 months, and better visual acuity at 12 months compared with eyes with no type 1 BB. Conversely, no significant differences between both groups were observed for graft survival, visual acuity at 24 and 36 months, and endothelial cell density at 12 and 36 months. Conclusion OCT assessment before DALK is useful for choosing trephination depth that should be as deep as possible and for looking for posterior scars. The BB technique may not be the most appropriate method in keratoconus with posterior scars. Follow-up data do not support the need for conversion to penetrating keratoplasty when type 1 BB cannot be obtained nor does it support the need for performing a penetrating keratoplasty as a first-choice procedure in eyes with posterior stromal scars.

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“…A large trephination size has been reported to be associated with an increase in the probability of successful big bubble formation in keratoconus eyes [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Borderie¹,

Touhami²,

Georgeon³

et al. 2018

Journal of Ophthalmology

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“…DALK with DM perforation is considered a surgical challenge with a reported incidence of 4.4%–39%. 1 5 16 17 18 Despite the widespread use of DALK, the management of such perforation remains a contentious topic, and there is variation in current practice toward the conversion to PKP. Since 2014, we started the implementation of a new concept, completing DALK surgery regardless of the size or the site of DM tears.…”

Section: Discussionmentioning

confidence: 99%

Deep Anterior Lamellar Keratoplasty with Large Descemet's Membrane Perforation

Goweida

Mahmoud

Sobhy

et al. 2021

Journal of Current Ophthalmology

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Purpose: To evaluate the outcome of eyes with large Descemet's membrane (DM) perforation during deep anterior lamellar keratoplasty (DALK). Methods: A retrospective, interventional case series of 12 eyes with completed DALK, despite DM perforation larger than 4 mm in its widest dimension. The main outcome measures included graft clarity, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and DM detachment. Results: The mean age of patients was 26.8 ± 11.4 years. Preoperative pathology included keratoconus ( n = 10), macular dystrophy ( n = 1), and postmicrobial keratitis corneal scar ( n = 1). The average size of DM perforation was 6.5 mm ± 1.3 mm. At the end of the follow-up period (median 15 months, range 6–53 months), the mean CDVA was 0.32 ± 0.09 logMAR and the mean ECD was 1830.8 ± 299.7 cells/mm 2 . Nine patients (75%) developed DM detachments postoperatively and was managed by intracameral air injection once in six eyes, and twice in three eyes. Other complications included persistent localized stromal edema at the site of DM defect in one eye and Urrets Zavalia syndrome in one eye. Conclusion: Completing DALK in eyes with large DM perforation provides good visual acuity, endothelial cell count and may be superior to penetrating keratoplasty regarding long-term graft survival if confirmed in future comparative studies.

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“…Although they did not clearly specify the types of BBs, Feiz et al . 25 , reported that male patients and large trephination sizes increased the rate at which detached bare DM was achieved in DALK. Furthermore, in prior reports of ex vivo studies of the BB technique, the rate of Type II BB formation was relatively low, ranging from 6.3% to 23.8% 12,16,26 .…”

Section: Discussionmentioning

confidence: 99%

Effect of Air Injection Depth on Big-bubble Formation in Lamellar Keratoplasty: an Ex Vivo Study

Yoo

Whang

Kang

et al. 2019

Sci Rep

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This study evaluated the effect of air injection depth in the big-bubble (BB) technique, which is used for corneal tissue preparation in lamellar keratoplasty. The BB technique was performed on ex vivo human corneoscleral buttons using a depth-sensing needle, based on optical coherence tomography (OCT) imaging technology. The needle tip, equipped with a miniaturized OCT depth-sensing probe, was inserted for air injection at a specified depth. Inside the corneal tissue, our needle obtained OCT line profiles, from which residual thickness below the needle tip was measured. Subjects were classified into Groups I, II, III, and IV based on injection depths of 75–80%, 80–85%, 85–90%, and >90% of the full corneal thickness, respectively. Both Type I and II BBs were produced when the mean residual thicknesses of air injection were 109.7 ± 38.0 µm and 52.4 ± 19.2 µm, respectively. Type II BB (4/5) was dominant in group IV. Bubble burst occurred in 1/16 cases of type I BB and 3/16 cases of type II BB, respectively. Injection depth was an important factor in determining the types of BBs produced. Deeper air injection could facilitate formation of Type II BBs, with an increased risk of bubble bursts.

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Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus

Cited by 37 publications

References 26 publications

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Predictive Factors for Successful Type 1 Big Bubble during Deep Anterior Lamellar Keratoplasty

Deep Anterior Lamellar Keratoplasty with Large Descemet's Membrane Perforation

Effect of Air Injection Depth on Big-bubble Formation in Lamellar Keratoplasty: an Ex Vivo Study

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